The question paper sent by Megha Reddy

PrePG UPSC CMS
#1

UPSC all the questions are directly taken line by line from Bailey 27th Edition… Yes as a part of routine marketing like others… More than 80 percent questions are direct repeats from Surgery Sixer book…and Surgery Sixer Classes…

The question paper sent by Megha Reddy…

UPSC 2018 Surgery Questions
Courtesy: Dr. Megha Reddy

  1. Cellulitis is (UPSC 2018)
    (a) A suppurative invasive infection of skin and subcutaneous tissues
    (b) A nonsuppurative invasive infection of tissues
    © Infection caused by Gram negative bacilli
    (d) Infection caused by anaerobic Streptococci

Ans. B ( Ref. Bailey and Love 27th Edition Page 48)

• Cellulitis is a non suppurative invasive infection of Tissues, related to point of injury.
• Poor localisation and Spreading infection seen.
• Caused by Beta Hemolytic Streptococci, Staphylococci and clostridium perfringens.
• Toxemia- Fever, Chills are common.
• Blood Culture is negative**

  1. Following are the factors for increased risk of wound infection EXCEPT (UPSC 2018)
    (a) Malnutrition
    (b) Good blood supply
    © Metabolic diseases (diabetes, uraemia)
    (d) Immunosuppression

Ans. B. Good Blood Supply ( Ref. Surgery Sixer 3rd Edition Page 33)

Systemic Factors causing non healing of Wound:
• Diabetes
• Radiation
• Extremes of age
• Hypothermia**
• Hypoxemia**
• Hypocholesterolemia**
• Hyperglycemia (Even if transit**)
• Malnutrition
• Vitamin C and A deficiency
• Zinc and Iron deficiency
• Drugs: Steroids and Doxorubicin
• Jaundice, Uremia and Malignancy
• Immunosuppressed State

  1. A 25 year old lady underwent exploratory laparotomy for bowel injury which happened while she underwent medical termination of pregnancy 2 days back. 24 hours after exploratory laparotomy her pulse is 106/m, respiratory rate 26/m, total leucocyte count 14000/cu.mm with blood urea 84 mg% and serum creatinine 2.0 mg/dL. The lady is having: (UPSC 2018)
    (a) Wound infection
    (b) Systematic inflammatory response syndrome
    © Sepsis syndrome
    (d) Multisystem organ failure (MSOF)

Ans. C. Sepsis Syndrome ( Ref. Surgery Sixer 3rd Edition)

SIRS
• Two or more of the following:
• Temperature >38°C or <35°C
• Heart rate >90 beats/min
• Respiratory rate >20 breaths/min or PaCO2 <32 mm Hg
• WBC count >12,000 or <4000/mm’
Sepsis
• SIRS + documented infection
Severe Sepsis
• Sepsis + one or more organ dysfunction or hypoperfusion (e.g., Iacticacidosis, oliguria, altered mental status)
Septic Shock
• Sepsis + organ dysfunction + hypotension (SBP <90 mm Hg or SBP >90 mm Hg with vasopressors)

Systemic Inflammatory Response Syndrome (SIRS)
• It is final common pathway in shock of any cause where there is failure of inflammatory localization with vasodilation, increased endothelial damage, thrombosis, leucocyte migration and activation**
• It is a part of severely decompensated reversible shock which eventually leads to multiple organ dysfunction syndrome (MODS), irreversible shock wherein patient is anuric, drowsy, cold and terminally ill.
• SIRS carries poor prognosis.

This question has along with SIRS features + Renal Dysfunction which can be hence mentioned as Severe Sepsis Syndrome**

4.A 22 year old young man came with history of occasional bleeding per rectum. On colonoscopy, numerous sessile polyps were seen in descending and sigmoid colon. On family history his elder brother was operated for thyroid malignancy. The young man should be advised( UPSC 2018)
(a) Prophylactic pan proctocolectomy
(b) Prophylactic anterior resection
© Surveillance colonoscopy every 6 months
(d) Colonoscopic removal of all polyps

Ans.a. Prophylactic Pan Proctocolectomy ( Ref. Bailey and Love 27th Edition Page 1260)

• Family H/o Thyroid Cancer is associated with FAP, and Colonoscopy shows numerous polyps. Hence a diagnosis of FAP is made.
• The treatment of Choice for FAP is Prophylactic TPC with Ileal Pouch Anal Anastomosis.

  1. A 47 year old post menopausal lady was on adjuvant hormonal treatment with Tamoxifen for 3 years for Carcinoma Breast. She came to Outpatient Department with history of passing blood clots per vagina. She is probably suffering from: (UPSC 2018)
    (a) Carcinoma Vulva
    (b) Carcinoma Vagina
    © Carcinoma Endometrium
    (d) Uterine fibroid

Ans. C. Carcinoma Endometrium ( Ref. Surgery Sixer 3rd Edition Page 276)
• Endometrial carcinoma is a dangerous complication on giving Tamoxifen due to continuous estrogenic stimulation on Endometrium.

  1. Gastric conduit after oesophageal resection is based upon: ( UPSC 2018)
    (a) Right Gastroepiploic artery
    (b) Short gastric vessels and Vasa brevia
    © Left gastric artery
    (d) Right gastric artery

Ans. A. Right Gastro epiploic artery ( Ref Surgery Sixer 3rd Edition Page 354)

  1. A 70 year old male having comorbidities present with benign appearing parotid tumour. The best option is: (UPSC 2018)
    (a) Tumour enucleation
    (b) Superficial Parotidectomy
    © Aspiration biopsy confirmation
    (d) Radio therapy
    Ans. C. Aspiration Biopsy Confirmation
    • No doubt any swelling we will confirm first with FNAC and decide further management.

  2. Fine Needle Aspiration Cytology (FNAC) is NOT conclusive in which one of the following thyroid swellings?
    (a) Papillary carcinoma thyroid
    (b) Follicular carcinoma thyroid
    © Medullary carcinoma thyroid
    (d) Thyroiditis
    Ans. B. Follicular Carcinoma ( Repeat Question)

9.Patients with phlebographically confirmed deep vein thrombosis of the calf:
(a) can expect asymptomatic recovery if treated promptly with anticoagulant
(b) may be effectively treated with low-dose heparin
© may be effectively treated with pneumatic compression stockings
(d) are at risk for significant pulmonary embolism

Ans, d. Are at risk of Significant Pulmonary Embolism ( Ref. Bailey and Love Page 990)

• Prevention is with Pneumatic Compression stockings , not treatment.
• Treatment is by LMWH, not low dose heparin.
• Asymptoatic recovery is less, 2/3rd patients develop Pelvic Thrombotic Syndrome ( PTS) apart from the most dangerous Pulmonary Embolism**

  1. Herceptin (Trastuzumab) is an immunotherapeuctic agent used for:
    (a) Carcinoma prostrate
    (b) Carcinoma breast
    © Carcinoma rectum
    (d) Ovarian malignancy
    Ans.B. Carcinoma Breast ( Repeat Question)

  2. Mainstay of an accurate diagnosis of pancreatic injury following blunt abdominal trauma is:
    (a) Computed Tomogram
    (b) Diagnostic peritoneal lavage
    © USG abdomen
    (d) MRI abdomen

Ans. A. CT abdomen ( Ref. Surgery Sixer Page 101)
• CECT is the IOC for Pancreas Injury

  1. Pancreatic pseudocysts developing complications are best managed by:
    (a) Conservative treatment
    (b) Radiologically guided interventions
    © External drainage
    (d) Surgery

Ans. C. External Drainage ( Ref. Surgery Sixer 3rd Edition Page 678)
• Infection is the MC complication of Pseudocyst
• External Drainage is the best method drainage of Infected Pseudocyst*

  1. Which one of the following regarding absorbable meshes is NOT true?
    (a) They are made of polyglycolic acid fibre
    (b) They are used in temporary abdominal wall closure
    © They are used to buttress sutured repair
    (d) They show very good results as collagen deposition is maximum

Ans. D. They show very good results as collagen deposition is maximum ( Ref. Bailey and love 27th Edition Page 1028/ Surgery Sixer Page 550)

Absorbable Mesh:

• Made up of Polyglycolic Acid fibre
• Used in Temporary abdominal wall closure
• Used to Buttress Sutured repairs.
• They have no role in Hernia repair, as they get absorbed and have minimal collagen deposition.

  1. Which one of the following is NOT a surgical modality for management of femoral hernia?
    (a) Lotheissen’s (Inguinal) operation
    (b) The high approach (Mc Evedy)
    © The low approach (Lockwood)
    (d) The canal ring narrowing operation (Lytle’s)

Ans. D. The canal ring narrowing operation ( Lytle’s repair)( Ref. Surgery Sixer Page 548)
• Lytle’s repair of narrowing Deep ring is done for Indirect hernia with dilated ring.

  1. “Triangle of Doom” dissected and seen during Laparoscopic inguinal hernia repair is bounded by all EXCEPT:
    (a) Vas deference
    (b) Gonadal Vessels
    © Peritoneal fold
    (d) Inferior epigastric artery
    Ans. D. Inferior Epigastric artery ( Ref. Surgery Sixer 3rd Page 548)
    • Vas deferns, Gonadal vessels and Peritoneum form the boundary of Doom Triangle

  2. Paralytic ileus is a type of:
    (a) Dynamic obstruction
    (b) Adynamic obstruction
    © Inflammatory obstruction
    (d) Drug induced obstruction
    Ans. B. Adynamic Obstruction ( Repeat)

  3. Indication of Coronary artery bypass grafting (CABG) is:
    (a) More than 25% stenosis of critical left main stem
    (b) More than 25% stenosis of proximal left anterior interventricular artery
    © Triple vessel disease
    (d) Deranged Stress Echocardiography report
    Ans. C. Triple vessel disease ( Ref. Surgery Sixer 3rd Edition Page 851)

Surgery is indicated for symptomatic or prognostic reasons.
• > 50% stenosis of the left main stem (critical left main disease)*
• >70% stenosis of the proximal left anterior inter ventricular artery.
• All three main coronary arteries diseased (Triple vessel disease)
• Poor ventricular function associated with coronary disease.

  1. Normal anatomical narrowing of ureter are present in all EXCEPT:
    (a) Ureteropelvic junction
    (b) Crossing the abdominal aorta
    © Entering bladder wall
    (d) Ureteric orifice

Ans. B. Crossing of Abdominal Aorta ( Ref. Surgery Sixer 3rd Edition Page 740)

  1. Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?
    (a) It is also called Grawitz tumour
    (b) It always presents with haematuria
    © It may be associated with Pyrexia of unknown origin
    (d) Renal vein extension may embolize to lungs

Ans. B. It always presents with Hematuria (Ref Surgery Sixer 3rd Edition Page 743)
• MC presentation is painless hematuria, but not always present.

  1. Which one of the following regarding abdominal paediatric surgery is correct?
    (a)Transverse abdominal incision is always used
    (b) Incision can be closed with absorbable suture
    © Bowel must be always anastomosed in double layer
    (d) Skin over abdomen can never be closed with subcuticular sutures

Ans. Incision can be closed with absorbable Suture ( Ref. Bailey and Love 27th Edition Page 122)

Principles of Paediatric Surgery:
• Transverse incisions are better than midline incisions.
• Abdominal incisions are closed with Absorbable Sutures.
• Bowel is anastomosed with single layer Extramucosal- Interrupted or Continuous sutures.
• Skin can be closed with Subcuticular sutures or Glue.

  1. Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:
    (a) Adult polycystic kidney
    (b) Fibromuscular dysplasia
    © Neurofibromatosis Type II
    (d) Marfan’s syndrome

Ans. C. NF- Type II ( ref. Surgery Sixer 3rd Edition Page 957)

Associated with
• ADPKD
• Ehler Danlos Syndrome
• Marfan’s Syndrome
• Fibromuscular dysplasia
• NF-1

  1. Allen’s test is used in Cardiac surgery:
    (a) To select finger prick for blood glucose estimation
    (b) When radial artery harvest is planned
    © For evaluation of AV fistula
    (d) To check warmth of hands

Ans. B. When Radial Artery Harvest is planned ( Repeat)

  1. In a lateral facial wound, if facial nerve injury is suspected, it should be:
    (a) Left alone
    (b) Skin and subcutaneous flaps to be raised to cover the cut ends
    © Primary repair should be attempted
    (d) Secondary repair using microscope gives best result

Ans. C. Primary Repair should be attempted ( Repeat)

24.Mallory-Weiss tear causing haematemesis is seen over:
(a) Oesophagus
(b) Gastroesophageal junction
© Anterior wall of stomach
(d) Fundus of stomach
Ans. B. GE junction ( Repeat)

  1. Sleeve Gastrectomy done for Morbid obesity is a:
    (a) Restrictive procedure
    (b) Reversible procedure
    © Mildly restrictive and mainly malabsorptive
    (d) Malabsorptive procedure only
    Ans. A. Restrictive procedure (Ref. Bailey and Love 27th Edition Page 1147)

  2. Pre-operative Nutrition Screening in a patient with morbid obesity planned for Gastric Bypass includes all EXCEPT:
    (a) Serum Magnesium
    (b) Serum Calcium
    © Serum Vitamin B12
    (d) Serum Insulin

Ans. D. Serum Insulin ( Ref. Bailey and Love 27th Edition Page

27.In postoperative care the long term risks after Bariatric Surgery include all EXCEPT:
(a) Protein Calorie Malnutrition
(b) Deep Vein Thrombosis
© Vitamin and Micronutrient depletion syndromes
(d) Weight regain

Ans. B. Deep Vein thrombosis ( Ref. Bailey and Love 27th Edition Page 1150)
• DVT is a early complication.
• All others are late complications.

  1. Hilton’s method of Incision and drainage of abscess has the advantage of:
    (a) Complete drainage of pus
    (b) Avoids injury to underlying vessels and nerves
    © Provides irrigation
    (d) Heals without scar
    Ans. B. Avoids injury to underlying vessels and nerves ( Repeat Question)

29.Indications of computed tomography after head injury include all EXCEPT:
(a) Glasgow Coma Scale < 13 at any point
(b) Open depressed fracture
© Mild head injury in a 50 year old man
(d) Amnesia > 30 minutes
Ans. C. Mild head injury in a 50 year old man. ( Ref. Bailey and Love 27th edition Page 330)

• Mild head injury 14/15 GCS is not an indication of surgery. They fall under discharge Criteria
• Age >65 years, Amnesia > 30 minutes are indications for CT brain

  1. Mondor’s disease is:
    (a) Thrombophlebitis of superficial veins of the breast and anterior chest wall
    (b) Other name for tuberculosis of breast
    © Rare type of chronic intramammary abscess
    (d) Named after the scientist who first coined the term “Actinomycosis of Breast”
    Ans. A. Thrombophlebitis of superficial veins of breast and anterior chest wall. ( repeat)

  2. Sengstaken-Blakemore tube is used to control bleeding in:
    (a) Renal trauma
    (b) Bleeding varices
    © Splenic injury in portal hypertension
    (d) Duodenal ulcer bleed

Ans. B. Bleeding Varices ( Repeat question)

  1. Which one of the following regarding Pancreatic effusion is correct?
    (a) Free fluid collection in Pleural cavity
    (b) Never associated with abdominal collection
    © Pancreatic stenting is to be done
    (d) Percutaneous drainage under image guidance is necessary
    Ans. D. Percutaneous drainage under image guidance is necessary. ( ref. Bailey and Love 27th Edition Page 1228)

Pancreatic Effusion:
• Encapsulated collection in Pleural cavity.
• Concomitant Pancreatic ascites present
• Connection may be present with intra abdominal collection seen.
• Percutaneous drainage is done under USG guidance