UPSC-CMS 2014 - Surgery PYQs Practice Questions

Q: A 40 year old man presented with a flat 1x1cm scaly, itchy black mole on the front of thigh. Examination did not reveal any inguinal lymphodenopathy. The best course of management would be:

Excision biopsy. ***Excision biopsy*** - A **flat, scaly, itchy, black mole** is highly suspicious for **melanoma**, and an excision biopsy provides the most accurate histopathological diagnosis and depth assessment. - This procedure removes the entire lesion with a narrow margin of normal-appearing skin, allowing for comprehensive evaluation of its nature and determining further management. *FNAC of lesion* - **Fine needle aspiration cytology (FNAC)** is generally used for evaluating palpable masses or lymph nodes, not primary skin lesions like a suspicious mole. - It provides only cellular samples, making it difficult to assess architectural features, depth of invasion, or determine definitive malignancy in skin lesions. *Incision biopsy* - An **incision biopsy** involves removing only a partial sample of the lesion, which can lead to sampling error and an inaccurate diagnosis if the most aggressive part is missed. - For suspected melanoma, an incomplete biopsy can compromise subsequent staging and definitive treatment planning. *Wide excision with inguinal lymphadenectomy* - This is an **overly aggressive initial approach** before a definitive diagnosis of melanoma and its stage has been established. - **Wide excision** is typically performed after an excision biopsy confirms melanoma and determines its depth, while **lymphadenectomy** is indicated for confirmed lymph node involvement. [Practice more Surgery PYQs on OnCourse]

Q: Indications of TURP for Benign Prostatic Hyperplasia (BPH) include: 1. Urinary flow rate of less than 10 mL/second 2. Residual volume of urine >100 mL 3. Serum level of prostatic specific antigen >10 ng/mL 4. Trabeculated Urinary bladder Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - Urinary flow rate ** 100 mL**, and the presence of a **trabeculated bladder** (indicating chronic bladder outlet obstruction) are all relevant indications for considering TURP in BPH. - These findings collectively suggest significant **obstruction** and potential complications of BPH that may warrant surgical intervention. *2, 3 and 4* - This option incorrectly includes a **PSA level > 10 ng/mL** as an indication for TURP, which is primarily a marker for **prostate cancer screening** and not a direct surgical indication for BPH. - While an elevated PSA might prompt further investigation (e.g., biopsy), it doesn't alone necessitate TURP for BPH symptoms. *1, 2 and 3* - This option also incorrectly includes **PSA level > 10 ng/mL** as an indication for TURP. - The other two points (low flow rate and high residual volume) are appropriate indications, but the inclusion of PSA makes this option incorrect. *1, 3 and 4* - This option includes **PSA level > 10 ng/mL** as an indication for TURP, which is incorrect. - Additionally, it omits **residual urine volume > 100 mL**, which is a significant indicator of obstruction and a common reason for considering TURP. [Practice more Surgery PYQs on OnCourse]

Q: Tongue fixation in a patient with carcinoma tongue is staged as

T4. ***T4*** - **Tongue fixation** in carcinoma of the tongue indicates advanced local disease classified as **T4a stage** according to AJCC TNM staging. - This finding suggests invasion of **extrinsic tongue muscles**, which causes loss of tongue mobility and represents moderately advanced local disease. - T4a tumors invade through cortical bone, involve the inferior alveolar nerve, floor of mouth, or skin of face, or in the case of tongue, involve deep extrinsic muscles causing fixation. *T1* - **T1 tumors** are small lesions measuring **≤2 cm** in greatest dimension with **depth of invasion (DOI) ≤5 mm**. - They are superficial without invasion of deep structures or causing any functional impairment like tongue fixation. *T2* - **T2 tumors** measure **≤2 cm with DOI >5 mm and ≤10 mm**, OR **>2 cm but ≤4 cm with DOI ≤10 mm**. - While larger than T1, they do not involve deep extrinsic muscles or cause tongue fixation. *T3* - **T3 tumors** are defined as tumors **>4 cm** OR **any tumor with DOI >10 mm**. - Although T3 indicates larger tumor size and deeper invasion, **tongue fixation** specifically indicates T4a stage due to involvement of extrinsic tongue musculature. [Practice more Surgery PYQs on OnCourse]

Question 1

A 40 year old man presented with a flat 1x1cm scaly, itchy black mole on the front of thigh. Examination did not reveal any inguinal lymphodenopathy. The best course of management would be:

Accepted Answer

Excision biopsy

Answer

FNAC of lesion

Answer

Incision biopsy

Answer

Wide excision with inguinal lymphadenectomy

Question 2

Indications of TURP for Benign Prostatic Hyperplasia (BPH) include:

1. Urinary flow rate of less than 10 mL/second
2. Residual volume of urine >100 mL
3. Serum level of prostatic specific antigen >10 ng/mL
4. Trabeculated Urinary bladder

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Question 3

Tongue fixation in a patient with carcinoma tongue is staged as

Accepted Answer

T4

Answer

T1

Answer

T2

Answer

T3

Question 4

Which is the most commonly used chemotherapy regimen in the adjuvant treatment following modified radical mastectomy in the estrogen receptor negative 35 year old female with breast cancer?

Accepted Answer

Cyclophosphamide + Adriamycin + 5-Fluorouracil

Answer

Adriamycin + 5-Fluorouracil

Answer

Cyclophosphamide + 5-Fluorouracil

Answer

Cyclophosphamide + Methotrexate + 5-Fluorouracil

Question 5

The following procedures are recommended for palliation in a patient with obstructive jaundice due to unresectable carcinoma of head of pancreas except:

Accepted Answer

Choledochoduodenostomy, gastrojejunostomy with pancreaticojejunostomy

Answer

Cholecystojejunostomy with jejunojejunostomy with gastrojejunostomy

Answer

Hepaticojejunostomy with gastrojejunostomy

Answer

Choledochoduodenostomy with gastrojejunostomy

Question 6

Which of the following are contraindications to salvaging accidentally injured spleen during operation?

1. Labile blood pressure
2. Presence of intraperitoneal infection
3. Pre-existing splenic disease
4. Age below 50 years

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 7

Treatment of choice for annular pancreas is

Accepted Answer

Duodenoduodenostomy

Answer

Resection

Answer

Pyloromyotomy

Answer

Gastrojejunostomy

Question 8

In a patient of gastric outlet obstruction nutritional support is best delivered by:

Accepted Answer

Jejunostomy

Answer

Enteral nutrition by Ryles tube

Answer

Gastrostomy

Answer

Parenteral nutrition

Question 9

The following nerves are blocked for repairing inguinal hernia by local anaesthetic except:

Accepted Answer

Femoral

Answer

Ilio-inguinal

Answer

Genito-femoral

Answer

Ilio-hypogastric

Question 10

Traumatic haemothorax is best managed by:

Accepted Answer

Intercostal tube drainage

Answer

Use of streptokinase

Answer

Open drainage

Answer

Aspiration of blood from pleural cavity

UPSC-CMS 2014 — Surgery