UPSC-CMS 2024 - Surgery Practice Questions

Q: Which of the following are stages of damage control surgery? 1. Patient selection 2. Control of haemorrhage 3. Resuscitation in ICU 4. Preventive surgery Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Damage control surgery** (DCS) is a multi-stage approach for critically injured patients, involving initial stabilization, followed by definitive repair. - The stages include **patient selection** (for those who would benefit), **initial hemorrhage and contamination control**, and subsequent **resuscitation in the ICU** before a final operation. *1, 3 and 4* - This option incorrectly includes **preventive surgery** as a stage of damage control surgery. - While patient selection and ICU resuscitation are crucial, preventive surgery is not a distinct stage within the standard damage control protocol, which focuses on immediate life-saving measures and delayed definitive repair. *1, 2 and 4* - This option incorrectly includes **preventive surgery** and omits **resuscitation in the ICU**, which is a critical phase of damage control. - After initial surgical control of bleeding and contamination, the patient undergoes aggressive resuscitation and optimization in the ICU before the next surgical stage. *2, 3 and 4* - This option omits **patient selection**, which is the crucial first step in determining who is a candidate for damage control surgery. - It also incorrectly includes **preventive surgery**, as outlined previously.

Q: Which of the following statements are correct regarding renal cell carcinoma? 1. It arises from the epithelium of the proximal convoluted tubule. 2. It has a female preponderance. 3. Major subtypes are clear cell, papillary and chromophobe. 4. Surgery is the mainstay of treatment for organ-confined disease. Select the answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Renal cell carcinoma (RCC)** most commonly arises from the **epithelium of the proximal convoluted tubule**, particularly the clear cell subtype [1]. This makes statement 1 correct. - The major subtypes of RCC are indeed **clear cell, papillary, and chromophobe carcinomas**, accounting for the vast majority of cases [1]. This validates statement 3. - For **organ-confined renal cell carcinoma**, **surgical resection (nephrectomy)** remains the primary and most effective treatment modality, making statement 4 correct. [1] *1, 2 and 3* - This option incorrectly includes statement 2, which claims a female preponderance for RCC. **Renal cell carcinoma is more common in males** than females, not the reverse [1]. - While statements 1 and 3 are correct regarding the origin and major subtypes of RCC, the inclusion of an incorrect epidemiological fact makes this option wrong. *1, 2 and 4* - This option falls short by incorrectly including statement 2, which asserts a female predominance for RCC. **RCC has a male predominance**, with a male-to-female ratio of about 2:1 [1]. - This option also omits statement 3, which correctly identifies the major subtypes (clear cell, papillary, and chromophobe), even though statements 1 and 4 are correct. *2, 3 and 4* - This option incorrectly includes statement 2, which states a female preponderance for RCC; **renal cell carcinoma is actually more prevalent in males** [1]. - While statements 3 and 4 are correct regarding the major subtypes and the role of surgery in organ-confined disease, the factual error in statement 2 invalidates this option.

Q: Extracorporeal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of

urinary tract stones. ***Urinary tract stones*** - **Extracorporeal Shock Wave Lithotripsy (ESWL)** is a non-invasive procedure primarily used to break down **kidney stones** and **ureteral stones** into smaller fragments. - The shock waves are generated outside the body and focused on the stone, allowing the fragments to be passed naturally in the urine. *Gallbladder stones* - **Gallbladder stones (cholelithiasis)** are typically treated with **cholecystectomy** (surgical removal of the gallbladder) or medications for dissolution, not ESWL. - While some research has explored ESWL for gallbladder stones, it is not the most common or preferred treatment due to high recurrence rates and limited efficacy. *Abdominal stony-hard tumour* - ESWL is designed to fragment **calcifications or stones**, not cellular masses or tumors. - Abdominal tumors, regardless of their consistency, require **biopsy for diagnosis** and subsequent treatment such as surgery, chemotherapy, or radiation, specialized based on pathophysiology. *Salivary gland stones* - **Sialolithiasis** (salivary gland stones) can sometimes be treated with **lithotripsy**, but this typically involves specific techniques like **endoscopic lithotripsy** or **interventional removal**, distinct from the general application of ESWL for urinary stones. - The most common treatments for salivary gland stones focus on hydration, massage, and, if necessary, surgical removal of the stone or gland.

Q: Which of the following are correct for herniation via foramen of Morgagni? 1. It occurs posteriorly in chest. 2. Transverse colon is the commonest content. 3. Defect is between sternal and costal attachments. 4. It is a type of congenital hernia. Select the answer using the code given below.

2, 3 and 4. ***2, 3 and 4*** - The **foramen of Morgagni** hernia (also known as a parasternal or retrosternal hernia) is a type of **congenital diaphragmatic hernia (CDH)** - statement 4 is **correct**. - The defect is located in the **anterior diaphragm**, specifically between the **sternal and costal attachments** - statement 3 is **correct**. - The **transverse colon** is indeed a common content (most common visceral organ), though omentum is actually the most frequent overall content - statement 2 is considered **correct** in clinical practice. - Statement 1 is **incorrect** as Morgagni hernias occur **anteriorly**, not posteriorly. *1, 3 and 4* - This option incorrectly includes statement 1, which claims the herniation occurs **posteriorly** in the chest. - **Morgagni hernias** are **anterior** diaphragmatic defects (parasternal location). - Posterior diaphragmatic hernias are **Bochdalek hernias**, not Morgagni hernias. *1, 2 and 4* - This option is incorrect because statement 1 states the hernia occurs **posteriorly**, which is wrong. - **Morgagni hernias** are located in the **anterior diaphragm** between sternal and costal attachments. - While statements 2 and 4 are correct, the inclusion of statement 1 makes this option incorrect. *1, 2 and 3* - This option is incorrect because statement 1 claims the hernia occurs **posteriorly**, which is inaccurate. - **Morgagni hernias** are **anterior** defects, representing only 2-3% of congenital diaphragmatic hernias. - The key distinguishing feature is the anterior parasternal location, not posterior.

Q: A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?

Acidosis with pH < 7.32. ***Acidosis with pH < 7.32*** - This represents **severe metabolic acidosis** and is a specific, measurable component of the **"lethal triad"** (acidosis, hypothermia, coagulopathy) that mandates damage control surgery. - pH < 7.32 provides a **defined threshold** indicating severe physiological derangement where prolonged definitive repair becomes dangerous and abbreviated surgery is required. *Blood pressure < 100 mm Hg* - While **hypotension** indicates shock requiring aggressive resuscitation, blood pressure < 100 mmHg alone is not a specific criterion for damage control surgery. - Damage control surgery is indicated by the **lethal triad** components, not by isolated blood pressure thresholds. *Hypothermia < 36 °C* - While **hypothermia** is part of the lethal triad, the standard threshold for damage control surgery is **core temperature 1.5, PT > 16-19 seconds) that would make it a definitive, measurable criterion compared to the specific pH threshold.

Q: A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates

fracture of the skull base. ***fracture of the skull base*** - A bruise over the mastoid process, known as **Battle's sign**, is a classic indicator of a **basilar skull fracture**. It signifies extravasation of blood from fracture lines in the skull base, typically involving the **temporal bone**. - This sign develops several hours to days after the injury as blood tracks subcutaneously, indicating severe trauma given the patient's altered consciousness. *injury to the external auditory meatus* - While head trauma can cause injury to the **external auditory meatus (EAM)**, a bruise over the mastoid process specifically points to deeper bone involvement, not just the EAM. - Injuries to the EAM might present with bleeding from the ear canal or local pain, but a mastoid bruise suggests a more extensive underlying fracture. *fracture of mastoid process* - Although Battle's sign is located on the mastoid process, it primarily indicates a fracture of the **skull base** (often involving the temporal bone, which includes the mastoid). - A fracture limited to the mastoid process itself might not necessarily cause the characteristic diffuse bruising pattern associated with Battle's sign, which results from blood tracking from deeper structures. *soft tissue injury to the neck* - A bruise over the mastoid process is anatomically distinct from the neck and does not directly indicate a **soft tissue injury to the neck**. - While neck injuries can accompany head trauma, Battle's sign is specific to a **cranial fracture**.

Q: A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

WHO surgical safety checklist. **WHO surgical safety checklist** - The questions about patient identity, procedure site, and anticipated critical events are key components of the **"Sign In"** and **"Time Out"** sections of the **WHO Surgical Safety Checklist**. - This checklist is designed to improve **patient safety** by ensuring communication and adherence to essential steps before, during, and after surgery, thereby reducing surgical errors. *nurses safety checklist* - While nurses play a crucial role in patient safety, there isn't a universally recognized "nurses safety checklist" that specifically encompasses these exact comprehensive surgical verification steps. - The comprehensive framework described, with its specific questions, aligns more closely with the broader, interdisciplinary **WHO Surgical Safety Checklist**. *universal precautions checklist* - **Universal precautions** focus on preventing the transmission of bloodborne pathogens and other infectious agents by treating all bodily fluids as potentially infectious. - This checklist primarily addresses **infection control** measures and does not cover patient identification, surgical site verification, or critical event anticipation. *MCI patient safety checklist* - A "MCI patient safety checklist" is not a widely recognized or standardized medical safety protocol. - The scenario describes a standard, internationally adopted set of safety checks specifically for surgical procedures, which is the **WHO Surgical Safety Checklist**.

Q: The best measure of organ perfusion and the best monitor of adequacy of shock therapy is

urine output. ***urine output*** - **Urine output** is a direct and sensitive indicator of **renal blood flow** and, consequently, overall organ perfusion [1]. Adequate urine production (typically >0.5 mL/kg/hr) signifies that the kidneys are being sufficiently perfused, which generally correlates with adequate perfusion of other vital organs. - In the context of shock, improved urine output following therapy indicates effective restoration of **circulating blood volume** and microcirculation, making it an excellent monitor for treatment adequacy. *restoring blood pressure/pulse vital parameters* - While restoring **blood pressure** and **pulse** is a critical goal in shock management, these parameters alone do not always reflect true tissue perfusion [1]. A patient can have normalized blood pressure due to **vasoconstriction** while still experiencing inadequate microcirculatory flow and cellular hypoxia. - These vital signs are systemic indicators, and while essential, they don't provide the same granular insight into **organ-level perfusion** as urine output. *central venous pressure* - **Central venous pressure (CVP)** primarily reflects the **right heart's filling pressure** and overall intravascular volume status [1]. While CVP helps guide fluid resuscitation, it is not a direct measure of organ perfusion. - CVP can be influenced by various factors, including **cardiac function** and **intrathoracic pressure**, and a "normal" CVP does not guarantee adequate perfusion to all organs [1]. *pulmonary wedge pressure* - **Pulmonary wedge pressure (PWP)**, also known as pulmonary artery occlusion pressure, reflects the **left atrial pressure** and serves as an indicator of left ventricular preload [1]. - While PWP is useful in assessing **cardiac function** and guiding fluid management in specific types of shock [1] (e.g., cardiogenic shock), it is not a primary measure of global organ perfusion or a universal monitor for adequacy of shock therapy.

Question 1

Which of the following are stages of damage control surgery?

1. Patient selection
2. Control of haemorrhage
3. Resuscitation in ICU
4. Preventive surgery
Select the correct answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 2

Which of the following statements are correct regarding renal cell carcinoma?

1. It arises from the epithelium of the proximal convoluted tubule.
2. It has a female preponderance.
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for organ-confined disease. Select the answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 3

Extracorporeal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of

Accepted Answer

urinary tract stones

Answer

gallbladder stones

Answer

abdominal stony-hard tumour

Answer

salivary gland stones

Question 4

Which of the following are correct for herniation via foramen of Morgagni?

1. It occurs posteriorly in chest.
2. Transverse colon is the commonest content.
3. Defect is between sternal and costal attachments.
4. It is a type of congenital hernia. Select the answer using the code given below.

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 5

A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?

Accepted Answer

Acidosis with pH < 7.32

Answer

Blood pressure < 100 mm Hg

Answer

Coagulopathy

Answer

Hypothermia < 36 °C

Question 6

A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates

Accepted Answer

fracture of the skull base

Answer

injury to the external auditory meatus

Answer

fracture of mastoid process

Answer

soft tissue injury to the neck

Question 7

A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

Accepted Answer

WHO surgical safety checklist

Answer

nurses safety checklist

Answer

universal precautions checklist

Answer

MCI patient safety checklist

Question 8

The best measure of organ perfusion and the best monitor of adequacy of shock therapy is

Accepted Answer

urine output

Answer

restoring blood pressure/pulse vital parameters

Answer

central venous pressure

Answer

pulmonary wedge pressure

UPSC-CMS 2024 — Surgery