UPSC CMSE Surgery Flashcards

24 sample cards from the Surgery deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. In posterior hip dislocation, how does the limb characteristically lie and which nerve is at risk?

   The limb is flexed, adducted, and internally rotated (and shortened). The SCIATIC nerve is at risk of injury.

2. Differentiate osteoarthritis from rheumatoid arthritis in pathology and joint involvement.

   Osteoarthritis: degenerative cartilage loss, affects weight-bearing joints (knee, hip), Heberden's/Bouchard's nodes, stiffness worse with use. Rheumatoid: autoimmune symmetric inflammatory synovitis of small joints (MCP, PIP), morning stiffness >1h, pannus, RF/anti-CCP positive.

3. Name the classic radiographic features of osteoarthritis.

   LOSS: Loss of joint space (asymmetric), Osteophytes, Subchondral sclerosis, Subchondral cysts.

4. What crystal causes gout, what is its appearance under polarized light, and the joint most affected?

   Monosodium urate crystals - needle-shaped with NEGATIVE birefringence under polarized light. The first metatarsophalangeal joint (podagra) is classically affected.

5. What is the most common primary malignant bone tumour, its age group, and classic X-ray sign?

   Osteosarcoma - most common in adolescents/young adults, typically around the knee (distal femur/proximal tibia). Classic signs: 'sunburst' appearance and Codman's triangle (periosteal elevation).

6. Describe Ewing's sarcoma: cell origin, age, X-ray appearance, and genetics.

   A small round blue cell tumour of children/adolescents, often in the diaphysis of long bones/pelvis, with an 'onion-skin' periosteal reaction on X-ray; associated with the t(11;22) translocation (EWS-FLI1).

7. What is a giant cell tumour (osteoclastoma) of bone - location and X-ray pattern?

   A locally aggressive (usually benign) tumour arising at the EPIPHYSIS/metaphysis of long bones (commonly distal femur/proximal tibia) after epiphyseal closure (20-40 yrs); shows a 'soap-bubble' lytic appearance.

8. Define osteomyelitis and name the most common causative organism.

   Osteomyelitis is infection/inflammation of bone and marrow. Staphylococcus aureus is the most common causative organism overall (Salmonella is classic in sickle-cell disease).

9. Define sequestrum and involucrum in chronic osteomyelitis.

   Sequestrum: a piece of dead, avascular bone separated from living bone (acts as a nidus for persistent infection). Involucrum: new living bone formed by the periosteum surrounding the sequestrum.

10. What is Pott's disease and which spinal region is most commonly affected?

    Pott's disease is tuberculous osteomyelitis (spondylitis) of the spine; it most commonly affects the lower THORACIC and thoracolumbar vertebrae, classically causing gibbus deformity and cold (paravertebral) abscess.

11. What is the most common cause of acute low back pain with sciatica, and the commonest level?

    Lumbar intervertebral disc prolapse (herniated nucleus pulposus) compressing a nerve root; the L4-L5 and L5-S1 levels are most commonly affected.

12. What is cauda equina syndrome and why is it a surgical emergency?

    Compression of the lumbosacral nerve roots causing saddle anaesthesia, bilateral sciatica, bladder/bowel dysfunction (urinary retention/incontinence) and lower-limb weakness. It is a surgical emergency requiring urgent decompression to avoid permanent deficits.

13. What is the most common organism causing uncomplicated urinary tract infection, and the typical urinalysis findings?

    Escherichia coli (uropathogenic). Urinalysis: pyuria (leucocytes), positive nitrites and leucocyte esterase, bacteriuria; significant culture ≥10^5 CFU/mL.

14. Differentiate cystitis from pyelonephritis clinically.

    Cystitis (lower UTI): dysuria, frequency, urgency, suprapubic pain, usually no fever. Pyelonephritis (upper UTI): high fever with rigors, flank pain, costovertebral angle tenderness, nausea/vomiting, systemic illness.

15. What is the most common type of urinary tract stone and the conditions favouring its formation?

    Calcium oxalate stones are most common (~70-80%). Favoured by hypercalciuria, hyperoxaluria, dehydration, and low urinary citrate; they are radio-opaque on X-ray.

16. Which urinary stone is associated with infection by urease-producing organisms, and what shape does it form?

    Struvite (magnesium ammonium phosphate, 'triple-phosphate') stones - associated with urease-producing bacteria (Proteus) and alkaline urine; they form large 'staghorn' calculi.

17. What is the classic clinical presentation of ureteric colic and the investigation of choice?

    Sudden severe colicky loin-to-groin pain, restlessness, with haematuria, nausea and vomiting. Non-contrast CT KUB is the investigation of choice (most sensitive); ultrasound is preferred in pregnancy.

18. Contrast benign prostatic hyperplasia (BPH) and prostate carcinoma in terms of zone of origin.

    BPH arises from the TRANSITIONAL (periurethral) zone, causing bladder outflow obstruction. Prostate carcinoma usually arises from the PERIPHERAL zone, allowing palpation as a hard nodule on digital rectal exam.

19. What tumour marker is used for prostate cancer, and which grading system describes its histology?

    Prostate-specific antigen (PSA) is the tumour marker. The Gleason score (grading group) describes histological differentiation; prostate adenocarcinoma classically metastasizes to bone (osteoblastic/sclerotic lesions).

20. What is the most common type of bladder cancer, its key risk factors, and cardinal symptom?

    Transitional cell (urothelial) carcinoma. Risk factors: smoking, aromatic amines (aniline dye/rubber industry), cyclophosphamide; schistosomiasis causes squamous cell carcinoma. Cardinal symptom: painless gross haematuria.

21. What is the most common malignant renal tumour in adults, the triad, and classic associated finding?

    Renal cell carcinoma (clear cell type, from proximal tubule). Classic triad: haematuria, flank pain, palpable mass (late). May cause left-sided varicocele (renal vein invasion) and paraneoplastic syndromes (polycythaemia, hypercalcaemia).

22. What is the most common renal malignancy in children and its typical age/presentation?

    Wilms' tumour (nephroblastoma) - typically in children under 5 years, presenting as a painless abdominal mass; associated with WT1 gene mutation and WAGR/Beckwith-Wiedemann syndromes.

23. Define azoospermia and distinguish obstructive from non-obstructive causes in male infertility.

    Azoospermia = complete absence of sperm in the ejaculate. Obstructive: normal spermatogenesis but blocked outflow (e.g., vasal/epididymal obstruction, absent vas deferens) - normal testes/FSH. Non-obstructive: testicular failure of spermatogenesis - small testes, raised FSH.

24. Why is varicocele a correctable cause of male infertility and which side is most commonly affected?

    Varicocele raises scrotal/testicular temperature and impairs spermatogenesis (low count and motility); it is surgically correctable. It is far more common on the LEFT (left testicular vein drains at a right angle into the renal vein).

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