General Surgery Principles Practice Questions

Q: Which classification best describes the surgical wound for an elective hemicolectomy for carcinoma of the colon?

Clean-contaminated. ### Explanation The classification of surgical wounds is based on the degree of microbial contamination at the time of surgery, which directly correlates with the risk of postoperative surgical site infection (SSI). **Why "Clean-contaminated" is correct:** An elective hemicolectomy involves the controlled entry into a hollow viscus (the colon) under elective, prepared conditions. According to the CDC classification, **Clean-contaminated (Class II)** wounds are those where the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Since the colon is part of the alimentary tract, its elective entry makes it a Class II wound. **Analysis of Incorrect Options:** * **Clean (Class I):** These are uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary, genital, or urinary tracts are **not** entered. Examples include hernia repair or thyroidectomy. * **Contaminated (Class III):** These involve open, fresh, accidental wounds or operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract. An elective procedure with controlled entry does not fall here. * **Dirty (Class IV):** These are old traumatic wounds with retained devitalized tissue or those that involve existing clinical infection or perforated viscera (e.g., perforated diverticulitis or a fecal abscess). **Clinical Pearls for NEET-PG:** * **Infection Rates:** Clean ( 27%). * **Key Distinction:** If a hollow viscus is entered, it is at least **Clean-contaminated**. If there is "spillage," it becomes **Contaminated**. If there is "pus/perforation" already present, it is **Dirty**. * **Cholecystectomy:** Elective is Clean-contaminated; however, if there is acute inflammation (acute cholecystitis), it is often classified as Contaminated.

Q: Which one of the following does not cause post-splenectomy septicemia?

Staphylococcus aureus. **Explanation:** The spleen plays a critical role in the body’s immune defense, particularly in filtering and phagocytosing **encapsulated bacteria**. Post-splenectomy, patients are at a lifelong risk of **Overwhelming Post-Splenectomy Infection (OPSI)**, which is primarily caused by organisms that require splenic opsonization for clearance. **Why Staphylococcus aureus is the correct answer:** *Staphylococcus aureus* is a Gram-positive coccus that is **not encapsulated**. While it can cause various infections, it is not a classic cause of the rapid, fulminant septicemia associated with the asplenic state. OPSI is specifically characterized by a failure to clear encapsulated organisms via the alternative complement pathway and splenic macrophages. **Why the other options are incorrect:** * **Streptococcus pneumoniae (Option A):** The most common cause of OPSI (responsible for 50–90% of cases). It is a heavily encapsulated organism. * **Haemophilus influenzae type b (Option C):** A major encapsulated pathogen, especially in children, against which splenectomy patients must be vaccinated. * **Neisseria meningitidis (Option B):** Another key encapsulated organism that causes rapid-onset sepsis and meningitis in asplenic individuals. **High-Yield Clinical Pearls for NEET-PG:** * **OPSI Timing:** Most common within the first **2 years** post-surgery, but the risk remains lifelong. * **Prevention:** Patients should receive vaccinations against *S. pneumoniae, H. influenzae,* and *N. meningitidis* ideally **2 weeks before** elective surgery or **2 weeks after** emergency surgery. * **Prophylaxis:** Daily oral penicillin is often recommended, especially in children, for at least 2 years post-splenectomy. * **Other Organisms:** Asplenic patients are also at increased risk of severe malaria and *Babesiosis* (transmitted by ticks).

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

Nylon. **Explanation:** Suture materials are broadly classified into **absorbable** and **non-absorbable** based on whether the body’s tissues will degrade and digest the material over time. **Correct Answer: D. Nylon (Polyamide)** Nylon is a synthetic, non-absorbable monofilament suture. It provides high tensile strength and undergoes very slow progressive hydrolysis, but for clinical purposes, it is considered permanent. It is the gold standard for skin closure because it causes minimal tissue reaction and has a smooth surface that prevents "bacterial wicking." **Incorrect Options:** * **A. Catgut:** A natural absorbable suture derived from the submucosa of sheep intestine or serosa of bovine intestine. It is degraded by enzymatic digestion. * **B. Fascia lata:** A biological material (autograft or allograft) used in reconstructive surgeries. Like all biological tissues used as sutures, it is eventually incorporated or absorbed by the body. * **C. Polyglycolic acid (Dexon):** A synthetic, braided, absorbable suture. It is degraded by hydrolysis rather than enzymatic action, leading to more predictable absorption rates and less inflammation than catgut. **High-Yield Clinical Pearls for NEET-PG:** * **Natural vs. Synthetic:** Natural sutures (Catgut, Silk) cause more tissue reaction than synthetic ones (Nylon, Prolene, Vicryl). * **Absorption Mechanism:** Natural sutures are absorbed by **proteolysis/enzymatic digestion**, while synthetic absorbable sutures are degraded by **hydrolysis**. * **Prolene (Polypropylene):** The non-absorbable suture of choice for vascular anastomoses and fascia closure (linea alba) due to its high tensile strength and inertness. * **Vicryl (Polyglactin 910):** A popular synthetic braided absorbable suture; its coated version is widely used for soft tissue approximation.

Q: Corpus callosotomy is useful in the treatment of which condition?

Epilepsy. **Explanation:** **Corpus callosotomy** is a palliative surgical procedure primarily used in the management of **refractory epilepsy**, specifically for patients who suffer from "drop attacks" (atonic seizures) or generalized tonic-clonic seizures that do not respond to medical therapy. **Why Epilepsy is the Correct Answer:** The corpus callosum is the largest white matter tract connecting the two cerebral hemispheres. In certain types of epilepsy, an electrical storm begins in one hemisphere and rapidly spreads to the other via these fibers, leading to a generalized seizure. By performing a "split-brain" surgery (severing the corpus callosum), the inter-hemispheric spread of synchronized electrical activity is interrupted. While this may not stop the focal seizure itself, it prevents generalization, thereby reducing the frequency and severity of drop attacks and improving patient safety. **Why Other Options are Incorrect:** * **Stroke:** Management involves thrombolysis, thrombectomy, or decompressive craniectomy (for edema). Surgery on the corpus callosum has no role in restoring blood flow or preventing ischemic damage. * **Alzheimer’s Disease:** This is a neurodegenerative condition characterized by amyloid plaques and tau tangles. Treatment is pharmacological (e.g., Donepezil); there is no surgical indication for callosotomy here. **High-Yield Clinical Pearls for NEET-PG:** * **Indication:** Best for **Atonic seizures** (drop attacks) and Lennox-Gastaut Syndrome. * **Extent:** Usually, an **anterior two-thirds callosotomy** is performed first to minimize "disconnection syndrome." * **Disconnection Syndrome:** A potential complication where the two hemispheres cannot communicate, leading to symptoms like alien hand syndrome or inability to name objects placed in the left hand (anomia). * **Vagus Nerve Stimulation (VNS):** Another high-yield neuromodulation technique used for refractory epilepsy.

Q: Which of the following causes the least irritation to the peritoneal cavity?

Blood. The severity of peritonitis depends on the pH, chemical composition, and bacterial load of the fluid entering the peritoneal cavity. **Explanation of the Correct Answer:** **Blood (Option B)** is the least irritating substance to the peritoneum. While blood acts as an excellent culture medium for bacteria (increasing the risk of delayed sepsis), it is chemically neutral and does not cause significant immediate chemical inflammation. Patients with a hemoperitoneum (e.g., ruptured ectopic pregnancy or splenic trauma) often present with surprisingly mild abdominal tenderness compared to those with hollow viscus perforation. **Analysis of Incorrect Options:** * **Gastric Juice (Option D):** This is the **most irritating** substance due to its extremely low pH (acidic). A perforated peptic ulcer causes immediate, intense "board-like" rigidity and agonizing pain (chemical peritonitis). * **Pancreatic Enzymes (Option C):** These are highly caustic. In acute pancreatitis, the release of activated trypsin and lipase leads to severe chemical fat necrosis and profound systemic inflammatory response. * **Bile (Option A):** Bile is highly irritating and causes intense chemical peritonitis. While sterile bile is less toxic than infected bile, it still causes significant fluid shifts and pain. **NEET-PG High-Yield Pearls:** 1. **Hierarchy of Peritoneal Irritation:** Gastric juice > Pancreatic juice > Bile > Urine > Blood. 2. **Clinical Sign:** The "Board-like rigidity" is most characteristic of perforated peptic ulcers (Gastric juice). 3. **Pneumoperitoneum:** While gastric juice is the most irritating, the presence of free air under the diaphragm is the classic radiological sign of hollow viscus perforation. 4. **Bacterial Peritonitis:** While blood is least irritating initially, it has the highest risk of secondary infection if bacteria are introduced.

Q: Surgically used suture material polydioxanone (PDS) undergoes which of the following processes?

Undergoes hydrolysis and complete absorption. **Explanation:** **Polydioxanone (PDS)** is a synthetic, monofilament, absorbable suture material. The core mechanism of its disappearance from the body is **non-enzymatic hydrolysis**. 1. **Why Option B is Correct:** Synthetic absorbable sutures (like PDS, Vicryl, and Monocryl) are broken down by hydrolysis—a process where water penetrates the polymer chains, causing them to fragment. PDS is known for its prolonged tensile strength (lasting up to 6 weeks) and is completely absorbed by the body within **180 to 210 days**. 2. **Why Options A, C, and D are Incorrect:** * **Option A:** Non-absorbable sutures (e.g., Silk, Prolene, Nylon) remain encapsulated by fibrous tissue; PDS is designed to be absorbed. * **Option C:** Phagocytosis and enzymatic degradation are characteristic of **natural absorbable sutures** (e.g., Surgical Catgut). Synthetic sutures are specifically engineered to avoid this inflammatory pathway to minimize tissue reaction. * **Option D:** Heart valves and synthetic grafts require permanent fixation, necessitating non-absorbable sutures like **Polypropylene (Prolene)** or **PTFE**. **High-Yield Clinical Pearls for NEET-PG:** * **Tensile Strength:** PDS retains ~50% of its strength at 4 weeks, making it ideal for tissues that heal slowly (e.g., abdominal fascia/rectus sheath closure). * **Monofilament Advantage:** Unlike braided sutures (Vicryl), PDS is a monofilament, which reduces the risk of "wicking" bacteria and surgical site infections. * **Metabolism:** The end products of PDS hydrolysis are primarily excreted in the urine. * **Comparison:** Remember: **Natural = Enzymatic/Proteolysis**; **Synthetic = Hydrolysis.**

Q: Which suture material is absorbed in approximately 180 days?

Polydioxanone. **Explanation:** The correct answer is **Polydioxanone (PDS)**. Suture materials are classified based on their absorption profile and origin. Polydioxanone is a synthetic, monocutaneous, absorbable polymer that provides prolonged tensile strength. **Why Polydioxanone is correct:** Polydioxanone is known for its slow absorption rate via **hydrolysis**. It maintains approximately 50% of its tensile strength at 4 weeks and is completely absorbed by the body in approximately **180 to 210 days**. This makes it ideal for tissues that heal slowly or require long-term support, such as the abdominal fascia (linea alba). **Why the other options are incorrect:** * **Catgut:** A natural absorbable suture (derived from bovine/ovine submucosa) that is absorbed rapidly via **proteolysis** within 7–10 days. * **Chromic Catgut:** Treated with chromic acid salts to delay absorption; it typically loses tensile strength in 10–14 days and is absorbed in about 90 days. * **Nylon:** A synthetic **non-absorbable** monofilament. While it may undergo very slow degradation over years, it is clinically classified as permanent. **High-Yield Clinical Pearls for NEET-PG:** * **Fastest absorption:** Catgut (7-10 days). * **Slowest absorption (Absorbable category):** Polydioxanone (180+ days). * **Mechanism of Absorption:** Natural sutures (Catgut) are absorbed by **proteolysis/enzymatic digestion** (causes more tissue reaction), while synthetic sutures (PDS, Vicryl) are absorbed by **hydrolysis** (less reaction). * **Vicryl (Polyglactin 910):** Absorbed in 60–90 days; a common "workhorse" suture in surgery.

Q: Which of the following is NOT a cause for burst abdomen?

Abdominal operation lasting more than two hours. **Explanation:** Burst abdomen (abdominal wound dehiscence) is a serious postoperative complication where the layers of the abdominal wall separate. The causes are generally categorized into **local factors** and **systemic (patient) factors**. **Why Option A is the Correct Answer:** While prolonged surgery can increase the risk of surgical site infection, an **operation lasting more than two hours** is not a direct, independent cause of burst abdomen. In clinical practice, many complex abdominal surgeries (like Whipple’s or total gastrectomy) routinely exceed two hours without resulting in dehiscence, provided the closure technique and patient factors are optimized. **Analysis of Incorrect Options:** * **Incomplete Suture (B):** This is a critical technical factor. If the suture bites are too small, too far apart, or if the knots slip, the mechanical integrity of the wound is lost, leading to immediate dehiscence. * **Infection (C):** Infection is the most common local cause. It leads to tissue friability and enzymatic degradation of collagen, which weakens the wound and prevents proper healing. * **Poor General Condition (D):** Systemic factors such as malnutrition (hypoproteinemia), anemia, vitamin C deficiency, jaundice, and chronic steroid use significantly impair collagen synthesis and wound tensile strength. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Burst abdomen typically occurs between the **5th and 8th postoperative day**. * **The "Pink Fluid" Sign:** The earliest clinical sign is a **serosanguinous (pinkish) discharge** from the wound. * **Most Common Cause:** Technical failure (improper suturing) is often cited as the leading cause. * **Management:** Immediate management involves covering the bowel with sterile saline-soaked gauze, followed by emergency re-closure using **tension sutures (interrupted mass closure)**.

Question 1

Which classification best describes the surgical wound for an elective hemicolectomy for carcinoma of the colon?

Accepted Answer

Clean-contaminated

Answer

Clean

Answer

Dirty

Answer

Contaminated

Question 2

Which one of the following does not cause post-splenectomy septicemia?

Accepted Answer

Staphylococcus aureus

Answer

Streptococcus pneumoniae

Answer

Neisseria meningitides

Answer

Haemophilus influenza

Question 3

Which of the following is NOT a premalignant ulcer?

Accepted Answer

Bazin's ulcer

Answer

Paget's disease of the nipple

Answer

Marjolin's ulcer

Answer

Lupus vulgaris

Question 4

Which of the following is a non-compressible swelling?

Accepted Answer

Lymphangioma

Answer

Meningocele

Answer

Mucocele

Answer

Cystic hygroma

Question 5

Which of the following is a non-absorbable suture material?

Accepted Answer

Nylon

Answer

Catgut

Answer

Fascialata

Answer

Polyglycolic acid

Question 6

Corpus callosotomy is useful in the treatment of which condition?

Accepted Answer

Epilepsy

Answer

Stroke

Answer

Alzheimer's disease

Answer

None of the above

Question 7

Which of the following causes the least irritation to the peritoneal cavity?

Accepted Answer

Blood

Answer

Bile

Answer

Pancreatic enzymes

Answer

Gastric juice

Question 8

Surgically used suture material polydioxanone (PDS) undergoes which of the following processes?

Accepted Answer

Undergoes hydrolysis and complete absorption

Answer

Is non-absorbable and remains encapsulated

Answer

Undergoes phagocytosis and enzymatic degradation

Answer

Is specifically used for heart valves or synthetic grafts

Question 9

Which suture material is absorbed in approximately 180 days?

Accepted Answer

Polydioxanone

Answer

Catgut

Answer

Chromic Catgut

Answer

Nylon

Question 10

Which of the following is NOT a cause for burst abdomen?

Accepted Answer

Abdominal operation lasting more than two hours

Answer

Incomplete suture

Answer

Infection

Answer

Poor general condition of patient

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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