UPSC-CMS 2025 - Surgery Practice Questions

Q: A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :

cT₂ N₁ Mₓ. **cT₂ N₁ Mₓ** - The tumor size of **3 x 4 cm** falls within the T2 classification (>2 cm but ≤5 cm). The description of the lump being "not fixed to the skin or the underlying structures" further supports a T2 (or lower) classification, as fixation would suggest a more advanced T stage (T4). - The presence of "firm mobile lymph nodes (level I)" indicates involvement of regional lymph nodes, which is classified as **N1** in breast cancer staging. An "Mx" designation means that distant metastasis cannot be assessed clinically without further investigation. *cT₃ N₁ Mₓ* - A **T3 classification** would apply if the tumor measured **greater than 5 cm** in its largest dimension, which is not the case here, as the lump is 3 x 4 cm. - While the **N1 and Mx** components are consistent with the findings, the T component is incorrect for the given tumor size. *cT₁ N₁ Mₓ* - A **T1 classification** is used for tumors that are **2 cm or less in greatest dimension**. The given tumor size of 3 x 4 cm clearly exceeds this limit. - The **N1 and Mx** components are consistent, but the T component is inappropriate for the described tumor size. *cT₃ N₂ Mₓ* - This option is incorrect on two counts: the **T3 classification** is wrong for a 3 x 4 cm tumor (should be >5 cm), and the **N2 classification** is also incorrect. - **N2** would indicate metastases to **ipsilateral axillary lymph nodes that are fixed or matted**, or in ipsilateral internal mammary lymph nodes in the absence of clinically apparent axillary lymph node metastases. The description states "firm mobile lymph nodes (level I)," which corresponds to N1, not N2.

Q: The commonest site of pressure sore is :

Heel. ***Heel*** - The **heel** is a common site for pressure sore development, especially in bedridden or immobile patients, due to sustained pressure on the bony prominence. - While less common as the *most* common site compared to the sacrum, it is still very frequently affected and can be equally severe. *Sacrum* - The **sacrum** is the *most common site* for pressure ulcers, particularly in individuals who are bed-bound or spend prolonged periods in a supine position. - This area experiences high pressure when lying on the back due to the body's weight pressing down on the bony prominence of the sacrum [1]. *Ischium* - The **ischial tuberosities** are common sites for pressure sores in individuals who are wheelchair-bound or spend extended periods in a seated position. - Pressure on this area is particularly high when sitting, making it vulnerable to tissue damage. *Occiput* - The **occiput** (back of the head) is a common site for pressure sores in infants, critically ill patients, or individuals who are supine for extended periods and unable to reposition their heads. - This is due to sustained pressure on the bony prominence of the skull against the mattress or support surface.

Q: Which of the following statements are correct regarding ABCDE of trauma care ? I. A stands for Airway with cervical spine protection II. B stands for Breathing and ventilation III. C stands for Control of massive external haemorrhage IV. D stands for Disability (Neurological status) Select the answer using the code given below :

I, II and IV. ***I, II and IV*** - All statements I, II, and IV accurately describe components of the **ABCDE approach in trauma care**. - **A** is for **Airway maintenance with cervical spine protection**, **B** for **Breathing and ventilation**, and **D** for **Disability (neurological status)**. - These are the core components as per **ATLS (Advanced Trauma Life Support) guidelines**. *I, II and III* - This option is incorrect because statement III is **incomplete and inaccurate**. - In the standard ATLS primary survey, **C stands for Circulation with hemorrhage control**, not just "Control of massive external haemorrhage." - While controlling hemorrhage is a critical part of 'C', the primary focus is on assessing and managing **circulation** (shock, perfusion, bleeding). - Note: ATLS 10th edition introduced ** for catastrophic hemorrhage** in tactical settings, but this is a separate step before A, not a replacement for C. *II, III and IV* - This option is incorrect as it omits statement I, which correctly describes **A as Airway with cervical spine protection**, the first and most critical step in trauma management. - Statement III also incorrectly describes what 'C' represents in the ABCDE approach. *I, III and IV* - This option is incorrect because it omits statement II, which correctly identifies **B as Breathing and ventilation**, an essential assessment following airway management. - Statement III is incomplete as it fails to mention that **C primarily stands for Circulation** (with hemorrhage control as one component).

Q: Which of the following statements are correct regarding Inguinal hernias in children? I. It is more common in premature boys. II. It should be repaired promptly. III. It is always indirect. IV. It may frequently be transilluminant. Select the answer using the code given below :

I, II and III. ***I, II and III*** - **Statement I is correct**: Inguinal hernias are significantly **more common in premature boys**, with an incidence of up to **30% in preterm infants** compared to 3-5% in term infants. Male predominance is marked (6-10:1 ratio). - **Statement II is correct**: Pediatric inguinal hernias should be **repaired promptly** (elective basis) due to the high risk of **incarceration and strangulation**, especially in infants under 1 year where the risk can be as high as 31%. - **Statement III is correct**: All inguinal hernias in children are **indirect hernias**, occurring through a **patent processus vaginalis**. Direct hernias are extremely rare in the pediatric population and represent adult pathology. - **Statement IV is incorrect**: Inguinal hernias are typically **NOT transilluminant** because they contain solid abdominal contents like bowel or omentum. **Transillumination** is a characteristic feature of **hydroceles** (fluid-filled), not hernias. *II and III* - While statements II and III are correct, this option is **incomplete** as it omits Statement I, which is also factually correct regarding the increased incidence in premature boys. *I, III and IV* - Statements I and III are correct, but **Statement IV is false**. Inguinal hernias do **not transilluminate** because they contain bowel or omentum, not fluid. Transillumination distinguishes hydroceles from hernias. *I, II and IV* - Statements I and II are correct, but **Statement IV is false** (hernias are not transilluminant), and Statement III is omitted despite being a fundamental characteristic of pediatric inguinal hernias (always indirect).

Question 1

A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :

Accepted Answer

cT₂ N₁ Mₓ

Answer

cT₃ N₁ Mₓ

Answer

cT₁ N₁ Mₓ

Answer

cT₃ N₂ Mₓ

Question 2

The commonest site of pressure sore is :

Accepted Answer

Heel

Answer

Sacrum

Answer

Ischium

Answer

Occiput

Question 3

Which one of the following is correct regarding splenic artery aneurysm?

Accepted Answer

It is most commonly located in the middle third of the splenic artery.

Answer

It is generally multiple in number.

Answer

It is caused due to blunt trauma to the abdomen.

Answer

It is twice as common in men.

Question 4

Which of the following statements are correct regarding primary survey/management of traumatic head injury patient?
I. Ensure adequate oxygenation and circulation
II. Exclude hypoglycaemia
III. Check for mechanism of injury
IV. Check pupil size and response

Select the answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 5

Which of the following statements are correct regarding ABCDE of trauma care ?
I. A stands for Airway with cervical spine protection
II. B stands for Breathing and ventilation
III. C stands for Control of massive external haemorrhage
IV. D stands for Disability (Neurological status)
Select the answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Question 6

Which of the following statements are correct regarding Inguinal hernias in children?
I. It is more common in premature boys.
II. It should be repaired promptly.
III. It is always indirect.
IV. It may frequently be transilluminant.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

II and III

Answer

I, III and IV

Answer

I, II and IV

UPSC-CMS 2025 — Surgery