General Surgery Principles Practice Questions

Q: Maximum tissue reaction is associated with which suture material?

Plain catgut. **Explanation:** The degree of tissue reaction to a suture material is primarily determined by its origin (natural vs. synthetic) and its structure (monofilament vs. multifilament). **Why Plain Catgut is correct:** Plain catgut is a natural, absorbable suture derived from the submucosa of sheep intestine or the serosa of bovine intestine. Because it is a **foreign animal protein**, it triggers a significant inflammatory response. Unlike synthetic sutures that undergo hydrolysis, catgut is degraded by **enzymatic digestion** by macrophages. This process results in the highest degree of tissue reaction among all commonly used sutures, leading to faster loss of tensile strength and increased scarring. **Why the other options are incorrect:** * **Polypropylene (A):** A synthetic, non-absorbable monofilament. It is chemically inert and associated with the **least** tissue reaction, making it ideal for vascular surgery and skin closure. * **Polyglyconate (B) & Polydioxanone (C):** These are synthetic, absorbable monofilaments. Because they are synthetic, they are broken down by **hydrolysis** rather than enzymatic action, resulting in minimal inflammatory response compared to natural materials like catgut. **NEET-PG High-Yield Pearls:** * **Most Inert Suture:** Polypropylene (Prolene) or Stainless Steel. * **Suture with Highest Tissue Reaction:** Plain Catgut > Chromic Catgut > Silk. * **Degradation Mechanism:** Natural sutures (Catgut, Silk) = Proteolysis/Enzymatic; Synthetic sutures (Vicryl, PDS, Monocryl) = Hydrolysis. * **Catgut Contraindication:** Never use in the presence of infection or for suturing the biliary/urinary tract (can act as a nidus for stone formation).

Q: A skin ulcer with undermined edges suggests which of the following conditions?

Tuberculosis. **Explanation:** The character of an ulcer’s edge is a classic clinical sign used to differentiate various pathologies. In this case, **Tuberculosis (TB)** is the correct answer because TB ulcers typically present with **undermined edges**. This occurs because the subcutaneous fat and connective tissue are destroyed more rapidly by the caseous necrosis than the overlying skin, causing the skin to "overhang" the floor of the ulcer. **Analysis of Options:** * **Tuberculosis (Correct):** Characterized by undermined edges, a bluish-purple hue of the surrounding skin, and a floor covered with pale, unhealthy granulations. * **Syphilis (Incorrect):** Tertiary syphilis (Gumma) typically presents as a **punched-out ulcer** with a "wash-leather" slough at the base. It is usually painless and circular. * **Cancerous Ulcer (Incorrect):** Malignant ulcers (like Squamous Cell Carcinoma) are characterized by **everted (rolled-out) edges** due to the rapid proliferation of neoplastic cells at the margin. * **Venous Ulcer (Incorrect):** These usually have **sloping edges**. They are commonly located in the "gaiter area" (medial malleolus) and are associated with chronic venous insufficiency and skin changes like lipodermatosclerosis. **High-Yield Clinical Pearls for NEET-PG:** * **Undermined edge:** Tuberculosis. * **Punched-out edge:** Syphilis, Trophic (Neuropathic) ulcers, Vasculitic ulcers. * **Everted edge:** Squamous cell carcinoma (Marjolin’s ulcer), Epithelioma. * **Sloping edge:** Healing traumatic or venous ulcer. * **Rolled-in (Inverted) edge:** Basal Cell Carcinoma (Rodent ulcer).

Q: What is the most common type of hernia in females?

Indirect inguinal hernia. **Explanation:** The correct answer is **Indirect inguinal hernia**. This is a classic high-yield concept in surgery that often confuses students due to the anatomical predisposition of females to femoral hernias. **1. Why Indirect Inguinal Hernia is Correct:** While femoral hernias are more common in females than in males, the **indirect inguinal hernia** remains the most common type of hernia in **both sexes**. In females, the indirect hernia occurs due to the patency of the *processus vaginalis* (Nuck’s canal), allowing abdominal contents to protrude through the deep inguinal ring. Statistically, the frequency of inguinal hernias far outweighs that of femoral hernias, even in the female population. **2. Analysis of Incorrect Options:** * **Direct Inguinal Hernia:** These occur through Hesselbach’s triangle due to an acquired weakness in the abdominal wall. They are significantly less common in females compared to males. * **Femoral Hernia:** This is the "trap" option. While it is true that femoral hernias are **more common in females than in males** (due to a wider bony pelvis), they are still less common than indirect inguinal hernias in females. * **Incisional Hernia:** These occur at the site of previous surgical scars. While common post-operatively, they do not surpass the baseline incidence of indirect inguinal hernias. **Clinical Pearls for NEET-PG:** * **Most common hernia overall (M/F):** Indirect Inguinal Hernia. * **Most common hernia in females:** Indirect Inguinal Hernia. * **Hernia with the highest risk of strangulation:** Femoral Hernia (due to the rigid boundaries of the femoral canal). * **Nuck’s Canal:** The female equivalent of the processus vaginalis; its failure to obliterate leads to indirect hernias in women.

Q: Colopotomy is done to treat which of the following?

Pelvic abscess. **Explanation:** **Colpotomy** (specifically posterior colpotomy) is a surgical procedure where an incision is made through the posterior vaginal wall into the **Pouch of Douglas (Rectouterine pouch)**. 1. **Why Pelvic Abscess is Correct:** The Pouch of Douglas is the most dependent (lowest) part of the peritoneal cavity in a female. Inflammatory processes (like PID or ruptured appendicitis) often lead to the accumulation of pus in this space, forming a **pelvic abscess**. A posterior colpotomy allows for direct, gravity-dependent drainage of this abscess through the vaginal vault, avoiding a more invasive laparotomy. 2. **Why Other Options are Incorrect:** * **Ischiorectal and Perianal Abscesses:** These are types of anorectal abscesses located in the perianal skin or the ischiorectal fossa (below the pelvic floor). They are drained via **external skin incisions** (usually cruciate incisions) near the anus, not through the vaginal wall. * **Appendicular Abscess:** While a pelvic abscess can result from appendicitis, a localized appendicular abscess in the right iliac fossa is typically drained percutaneously (ultrasound-guided) or via an abdominal approach (extraperitoneal drainage). **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** A pelvic abscess typically presents with swinging fever, diarrhea, and mucus discharge per rectum (due to irritation of the anterior rectal wall). * **Diagnosis:** On Per-Vaginal (PV) or Per-Rectal (PR) examination, a **tender, boggy swelling** is felt in the posterior fornix or anterior rectal wall. * **Culdocentesis:** This is the aspiration of fluid from the Pouch of Douglas via the posterior fornix, used to diagnose hemoperitoneum (e.g., ruptured ectopic pregnancy) or pus. * **Anatomical Landmark:** The incision for posterior colpotomy is made between the uterosacral ligaments.

Q: Name the incision.

Chevron incision. ***Chevron incision*** - A **bilateral subcostal incision** that extends horizontally across the upper abdomen, creating a "rooftop" or inverted V-shape appearance. - Provides excellent **exposure to the liver, gallbladder, and upper abdominal organs**, commonly used for hepatobiliary procedures and liver transplantation. *Kocher's incision* - A **right subcostal incision** that runs parallel to the right costal margin, limited to one side only. - Primarily used for **open cholecystectomy** and right upper quadrant procedures, not bilateral like the image shows. *Lanz incision* - A **transverse incision in the right iliac fossa**, positioned lower in the abdomen over McBurney's point. - Specifically designed for **appendectomy procedures**, located much lower than the subcostal region shown. *Maylard incision* - A **transverse incision in the lower abdomen** that cuts through the rectus abdominis muscles. - Used for **gynecological procedures** and lower abdominal access, positioned significantly below the costal margins.

Q: Which of the following statements about surgical wounds is incorrect?

Incision of an abscess is considered a contaminated wound.. ### Explanation The classification of surgical wounds is a high-yield topic based on the **CDC Surgical Wound Classification**, which predicts the risk of postoperative surgical site infection (SSI). #### Why Option B is Incorrect (The Correct Answer) Incision and drainage of an abscess is classified as a **Dirty (Class IV)** wound, not a contaminated wound. Dirty wounds involve clinical infection, perforated viscera, or old traumatic wounds with retained devitalized tissue. Since an abscess contains active pus and established infection, it falls into this highest risk category. #### Analysis of Other Options * **Option A:** In **Clean (Class I)** surgeries (e.g., hernia repair, thyroidectomy), the respiratory, alimentary, or genitourinary tracts are not entered. Prophylactic antibiotics are generally not required unless a prosthetic implant is used. * **Option C:** A **Clean-Contaminated (Class II)** wound involves controlled entry into a hollow viscus. However, if there is a major break in technique or **gross spillage** of contents (like stomach or biliary contents), it is upgraded to a **Contaminated (Class III)** wound. * **Option D:** The expected infection rate for Clean-Contaminated wounds, when proper technique and prophylaxis are used, is typically **between 3% and 10%**. #### NEET-PG High-Yield Pearls * **Clean (Class I):** No inflammation; no tracts entered. SSI risk: <2%. * **Clean-Contaminated (Class II):** Controlled entry into tracts (e.g., elective cholecystectomy, appendectomy). SSI risk: 3–10%. * **Contaminated (Class III):** Accidental wounds, gross spillage, or acute non-purulent inflammation. SSI risk: 10–20%. * **Dirty (Class IV):** Pus present, perforated viscera (e.g., perforated diverticulitis). SSI risk: 20–40%.

Q: Which of the following is a non-absorbable suture?

Polypropylene. **Explanation:** The classification of suture materials into **absorbable** and **non-absorbable** is a fundamental concept in surgery, determined by whether the body’s tissues can degrade and digest the material over time. **1. Why Polypropylene is Correct:** **Polypropylene (Prolene)** is a synthetic, monofilament, **non-absorbable** suture. It is biologically inert and maintains its tensile strength indefinitely because it is not degraded by host enzymes or hydrolysis. It is the material of choice for vascular anastomoses, abdominal wall closure (linea alba), and subcuticular skin closure due to its high tensile strength and low tissue reactivity. **2. Why the other options are incorrect:** * **Polyglycolic acid (Dexon):** This is a synthetic, braided, **absorbable** suture. It is degraded via **hydrolysis** and typically loses its tensile strength within 3–4 weeks. * **Collagen:** This is a natural **absorbable** suture derived from the submucosa of sheep intestine or serosa of cattle. It is degraded by **proteolytic enzymatic digestion**. "Catgut" is the most common example of a collagen-based suture. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Degradation:** Natural sutures (Silk, Catgut) are degraded by **proteolysis**, whereas synthetic sutures (Vicryl, PDS, Dexon) are degraded by **hydrolysis**. * **Suture of Choice:** * **Vascular surgery:** Polypropylene (due to its plasticity and low friction). * **Biliary/Urinary tract:** Absorbable sutures (to prevent them from acting as a nidus for stone formation). * **Infected wounds:** Monofilament (like Nylon or Prolene) is preferred over braided (like Silk or Vicryl) to prevent bacterial "wicking." * **Steel:** The strongest non-absorbable suture, often used for sternal closure.

Q: Splenectomy is contraindicated in which of the following hemolytic anemias?

Stomatocytosis. **Explanation:** **1. Why Stomatocytosis is the Correct Answer:** Hereditary Stomatocytosis (specifically the overhydrated subtype) is a rare hemolytic anemia where the red cell membrane is abnormally permeable to cations. Splenectomy is **contraindicated** in these patients because it is associated with a life-threatening risk of **severe thromboembolic complications** (such as portal vein thrombosis and pulmonary hypertension). Unlike other hemolytic anemias, the clinical benefit of splenectomy in stomatocytosis is minimal compared to the high risk of fatal clotting events. **2. Why the Other Options are Incorrect:** * **Hereditary Elliptocytosis (Option B):** Splenectomy is the treatment of choice for patients with symptomatic, severe hemolysis or significant anemia. It effectively increases the lifespan of the elliptical red cells. * **Sickle Cell Disease (Option C):** While patients often undergo "autosplenectomy" due to repeated infarcts, surgical splenectomy is indicated in specific cases such as **acute splenic sequestration crisis** or hypersplenism. It is not contraindicated; rather, it can be life-saving in these acute scenarios. **Clinical Pearls for NEET-PG:** * **Hereditary Spherocytosis:** Splenectomy is the **gold standard** treatment (usually performed after age 5-6 to reduce sepsis risk). * **Post-Splenectomy Sepsis (OPSI):** Most commonly caused by *Streptococcus pneumoniae*. Vaccination against encapsulated organisms (Pneumococcus, Meningococcus, H. influenzae) should be given 2 weeks before elective surgery. * **Peripheral Smear Finding:** Look for **Howell-Jolly bodies** post-splenectomy, which indicate absent splenic filtration. * **Absolute Contraindication:** Splenectomy should never be performed in asymptomatic patients or those with mild compensation where the risks of surgery outweigh the benefits.

Question 1

What is the major disadvantage of a peripheral intravenous line?

Accepted Answer

Thrombophlebitis

Answer

Catheter-related sepsis

Answer

Damage to adjacent artery

Answer

Refeeding syndrome

Question 2

Maximum tissue reaction is associated with which suture material?

Accepted Answer

Plain catgut

Answer

Polypropylene

Answer

Polyglyconate

Answer

Polydioxanone

Question 3

A skin ulcer with undermined edges suggests which of the following conditions?

Accepted Answer

Tuberculosis

Answer

Syphilis

Answer

Cancerous ulcer

Answer

Venous ulcer

Question 4

A patient with an abdominal wall desmoid tumor should be screened for which of the following conditions?

Accepted Answer

Colonic polyps

Answer

Lung cancer

Answer

Breast cancer

Answer

Pancreatic cancer

Question 5

What is the most common type of hernia in females?

Accepted Answer

Indirect inguinal hernia

Answer

Direct inguinal hernia

Answer

Femoral hernia

Answer

Incisional hernia

Question 6

Colopotomy is done to treat which of the following?

Accepted Answer

Pelvic abscess

Answer

Ischeorectal abscess

Answer

Appendicular abscess

Answer

Perianal abscess

Question 7

Name the incision.

Accepted Answer

Chevron incision

Answer

Kocher's incision

Answer

Lanz incision

Answer

Maylard incision

Question 8

Which of the following statements about surgical wounds is incorrect?

Accepted Answer

Incision of an abscess is considered a contaminated wound.

Answer

No antibiotics are required in clean surgery.

Answer

Spillage of stomach contents converts a clean-contaminated case to a contaminated case.

Answer

In clean-contaminated wounds, the infection rate is less than 10%.

Question 9

Which of the following is a non-absorbable suture?

Accepted Answer

Polypropylene

Answer

Polyglycolic acid

Answer

Collagen

Answer

All

Question 10

Splenectomy is contraindicated in which of the following hemolytic anemias?

Accepted Answer

Stomatocytosis

Answer

Elliptocytosis

Answer

Sickle cell disease

Answer

All of the above

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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