General Surgery Principles Practice Questions

Q: A woman presents 4 days after a laparotomy with complete wound dehiscence. After prescribing antibiotics the surgeon decides to suture the wound. Which of these suture materials should he use?

Ethilon. ***Ethilon*** * **Ethilon** (nylon) is a **non-absorbable monofilament suture** that is ideal for skin closure, especially in infected or contaminated wounds, because its smooth surface resists bacterial colonization. * Given the wound dehiscence and the potential for infection (antibiotics prescribed), a non-absorbable suture like Ethilon is preferred to provide strong, long-lasting support for surgical closures. *Mersilk* * **Mersilk** (braided silk) is a **non-absorbable multifilament suture** known for its excellent handling properties and knot security. * However, its **multifilament nature** can harbor bacteria in the setting of contaminated or infected wounds, making it less suitable than monofilament sutures for this scenario. *Vicryl* * **Vicryl** (polyglactin 910) is a **synthetic absorbable multifilament suture**. While strong initially, it loses tensile strength over several weeks. * In the context of a dehisced wound requiring long-term support and the potential for infection, an **absorbable suture** would not provide adequate prolonged wound closure strength. *Chromic catgut* * **Chromic catgut** is a **natural absorbable multifilament suture** that offers very short-term tensile strength, absorbed rapidly by the body. * It is generally **not recommended for skin closure**, especially in a reopened surgical wound, due to its rapid degradation and risk of promoting infection.

Q: The method of ulcer healing shown below generates a pressure of: (Recent NEET Pattern 2016-17)

Minus 125 mm Hg. ***Minus 125 mm Hg*** - The image depicts **Negative Pressure Wound Therapy (NPWT)**, also known as vacuum-assisted closure (VAC), which applies subatmospheric pressure to promote wound healing. - The standard therapeutic pressure for NPWT is **-125 mmHg**, which aids in wound contraction, granulation tissue formation, removal of exudate, and increased blood flow to the wound bed. - This pressure setting is well-established in clinical practice and supported by surgical literature. *Minus 100 cm of water* - While this represents negative pressure, **mmHg is the standard unit** used for measuring and reporting NPWT pressure settings, not cm H₂O. - Converting -100 cm H₂O to mmHg yields approximately -73.5 mmHg, which is lower than the commonly effective therapeutic pressure range for NPWT. *Plus 100 cm of water* - This indicates **positive pressure**, whereas NPWT fundamentally relies on **negative (subatmospheric) pressure** to achieve its therapeutic effects. - Positive pressure would not facilitate wound fluid removal, tissue contraction, or granulation tissue formation as intended by NPWT. *Plus 125 cm of water* - This represents **positive pressure**, which contradicts the core mechanism of action of **Negative Pressure Wound Therapy**. - Positive pressure would push against the wound rather than creating the suction needed to draw out exudate and promote wound closure.

Q: Identify the instrument shown in the image:

Asepto syringe. ***Asepto syringe*** - The image displays a **red rubber bulb** attached to a glass or plastic barrel ending in a nozzle, which is characteristic of an **Asepto syringe**. - Asepto syringes are commonly used for **irrigation** of wounds or surgical sites, and for various procedures where precise suction or fluid delivery is needed without a needle. *Trocar for tapping hydrocele* - A **trocar** is a pointed medical instrument with a sharp tip, typically used with a cannula to introduce instruments or drain fluids from a body cavity. - Trocars for hydrocele tapping would differ significantly in appearance, featuring a pointed tip and often a stylet, which are absent here. *Czerny retractor* - A **Czerny retractor** is a surgical instrument with two blades, used primarily to hold back tissue during surgery to provide a clear view of the surgical field. - The instrument shown here is focused on fluid suction/delivery, not on tissue retraction. *Malecot catheter* - A **Malecot catheter** is a type of self-retaining catheter, typically made from soft, flexible material, with a distinctive mushroom-shaped tip that helps anchor it within a viscus. - This image clearly depicts a syringe-like device with a bulb, not a flexible catheter with a four-winged tip.

Q: Which is correct about the suture material shown in the image?

Absorbed by phagocytosis and enzymatic degradation. ***Absorbed by phagocytosis and enzymatic degradation*** - This description is characteristic of **natural absorbable sutures**, such as **catgut** (which appears to be depicted by the golden, multi-filament material with a needle). Catgut is absorbed by the body's enzymatic processes and macrophage activity. - This type of absorption is a key feature distinguishing natural absorbable sutures from synthetic ones (which are absorbed by hydrolysis) and non-absorbable sutures. *It is less reactive* - Natural absorbable sutures like catgut are generally associated with a **higher inflammatory reaction** in tissues compared to synthetic absorbable sutures due to their proteinacious nature. - The body's immune system recognizes these natural proteins, leading to a more pronounced foreign body response. *Derived from cat gut mucosa* - **Catgut sutures** are indeed derived from the sub-mucosal layer of the sheep or goat **intestine**, not the mucosa itself. - The term "catgut" is historical and misleading, as it is not derived from cats. *Used for bowel anastomosis* - While absorbable sutures are used for bowel anastomosis, the use of **plain catgut** (which the image suggests due to its color and appearance) is generally not preferred for critical anastomoses due to its variable and rapid absorption time, which can compromise wound strength before healing is complete. - **Chromic catgut** or synthetic absorbable sutures (like Vicryl or PDS) with more predictable absorption profiles are typically favored for bowel anastomoses.

Q: Which retractor is shown in the image?

Deaver retractor. ***Deaver retractor*** - The Deaver retractor is easily identifiable by its distinct **flat, C-shaped, curved blade** at one end and a **long handle with a fenestrated grip**. - It is commonly used in deep abdominal and thoracic procedures to **retract organs and tissues**, providing excellent exposure. *Morris retractor* - The Morris retractor typically features a **curved blade** that is less pronounced than a Deaver and often includes a **fenestrated handle**. - However, its blade is generally **flatter and broader** compared to the distinctive C-shape of the Deaver. *Langenbeck retractor* - A Langenbeck retractor is characterized by a **small, L-shaped blade** and a handle, designed for retracting small incisions and delicate tissues. - Its blade is significantly smaller and has a **sharper, angled bend** compared to the broad, C-shaped blade shown. *Doyen retractor* - The Doyen retractor, also known as a Doyen rib raspatory, is typically used to **retract ribs** and protect lung tissue during thoracic surgeries. - It has a distinctive **hooked end** or a spoon-like blade, which is quite different from the broad, curved blade in the image.

Q: A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Absorbed by phagocytosis and enzymatic degradation. ***Absorbed by phagocytosis and enzymatic degradation*** - The image shows a **braided absorbable suture**, which undergoes absorption through **tissue reaction** involving enzymatic breakdown and phagocytosis - This is the characteristic mechanism of absorption for most **absorbable sutures** (both natural like catgut and synthetic like Vicryl, Monocryl, PDS) - The body's macrophages phagocytose suture particles while proteolytic enzymes break down the material components, allowing complete removal from tissues *Derived from catgut* - While **catgut sutures** (derived from sheep/bovine intestinal submucosa) are absorbable, modern synthetic absorbable sutures like **polyglactin (Vicryl)** or **polyglycolic acid (Dexon)** are more commonly used - The image appearance and braided structure suggest a synthetic absorbable suture rather than catgut - Catgut is less commonly used today due to higher tissue reactivity and unpredictable absorption *Non-absorbable* - **Non-absorbable sutures** (silk, nylon, polypropylene) remain permanently in tissues or require removal - The mechanism of absorption by phagocytosis and enzymatic degradation specifically defines **absorbable sutures**, making this option incorrect - Non-absorbable sutures maintain tensile strength indefinitely *Absorbed over 3 months* - Absorption time varies significantly by suture type: **rapidly absorbing gut (5-7 days)**, **Vicryl (56-70 days)**, **PDS (180-210 days)** - While some sutures absorb around 90 days, this is not a universal characteristic - The statement is too specific and not applicable to all absorbable sutures shown

Q: The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Nyhus Type IIIB. ***Nyhus Type IIIB*** - The image shows a hernia occurring within **Hesselbach's triangle**, which is the anatomical site for a **direct inguinal hernia**. A direct inguinal hernia is classified as **Nyhus Type III**, as it involves a defect in the posterior wall of the inguinal canal, medial to the inferior epigastric vessels. - The "B" in Nyhus Type IIIB specifically denotes a **direct inguinal (III) hernia with a weakness in the posterior inguinal wall**. While the question asks for the specific Nyhus classification, options like Nyhus Type I, Type II, and Type IIIA, as well as a femoral hernia (Nyhus Type IV), are inconsistent with the highlighted location. *Nyhus Type I* - This classification refers to an **indirect inguinal hernia** where the internal ring is normal, typically seen in children. - It would originate lateral to the inferior epigastric artery, unlike the highlighted region. *Nyhus Type II* - This type describes an **indirect inguinal hernia** with an enlarged internal ring but an intact posterior inguinal wall. - This type of hernia would still originate lateral to the inferior epigastric vessels, not within Hesselbach's triangle. *Nyhus Type IIIA* - Nyhus Type IIIA specifically classifies an **indirect inguinal hernia** with an enlarged internal ring and a completely destructed transversalis fascia. - While it's also a Type III (indirect), Type IIIA refers to an indirect hernia, which emerges lateral to the inferior epigastric vessels, whereas a direct hernia (within Hesselbach's triangle) emerges medial to these vessels. *Nyhus Type IV* - This classification is for a **femoral hernia**, which occurs inferior to the inguinal ligament and through the femoral canal. - The highlighted area is clearly superior to the inguinal ligament and within the inguinal region, not the femoral region.

Q: The image shows a child with acute lymphoblastic leukemia. Identify the type of catheter shown:

Hickman catheter. ***Hickman catheter*** - The image clearly displays a **tunneled central venous catheter** with an external segment, consistent with a Hickman catheter. These catheters are used for long-term venous access, crucial for patients undergoing chemotherapy for conditions like acute lymphoblastic leukemia. - Hickman catheters are characterized by a **cuff** that promotes tissue ingrowth, anchoring the catheter and reducing infection risk, and having one or more lumens for infusions, blood draws, and medication administration. *Malecot catheter* - A Malecot catheter is a **self-retaining suprapubic catheter** typically used for bladder drainage, not for long-term venous access and multiple infusions. - Its design features winged tips that expand to hold it in place within an organ, which is distinct from the central venous access device shown. *Cimino-Brescia catheter* - A Cimino-Brescia fistula is an **arteriovenous fistula** created surgically for hemodialysis access, involving the direct connection of an artery and a vein. It is not an external catheter like the one pictured. - This option refers to a vascular access point rather than a catheter, and it's used for **dialysis**, not primarily for chemotherapy administration in the manner shown. *Peripherally inserted centrally catheter* - A peripherally inserted central catheter (PICC) is inserted into a peripheral vein (usually in the arm) and threaded into a central vein. While also a central venous catheter, it does not typically exit the chest wall as depicted. - Although it provides central venous access, the visual representation of the catheter exiting the chest through a subcutaneous tunnel indicates a **tunneled catheter**, not a PICC line typically inserted in the arm.

Q: A 60-year-old male presents to the emergency department on the second day of symptom onset with progressive deterioration of consciousness due to large right MCA territory infarct. Which of the following is the most appropriate management? (Image: img-179.jpeg)

Decompressive surgery. ***Decompressive surgery*** - A large **MCA territory infarct** causes significant brain edema, leading to increased **intracranial pressure** and progressive deterioration of consciousness, especially on day 2. - **Decompressive craniectomy** is often necessary in such cases to reduce pressure, prevent herniation, and improve outcomes by removing a portion of the skull. *Anticoagulation* - Anticoagulation is primarily used for preventing future thrombotic events due to conditions like **atrial fibrillation**, or for managing an evolving stroke if there's no major hemorrhage risk. - In the setting of a **large ischemic stroke** with significant edema and risk of hemorrhagic transformation, anticoagulation can increase the risk of bleeding into the infarct. *Dual antiplatelet therapy* - **Dual antiplatelet therapy** (DAPT) is typically used to prevent recurrent ischemic events following a **minor stroke** or **transient ischemic attack (TIA)**. - It is not indicated for managing acutely deteriorating consciousness due to brain edema in a **large established infarct**. *Mechanical thrombectomy* - **Mechanical thrombectomy** is an acute intervention performed within a narrow time window (typically up to 24 hours in select patients, but ideally much earlier) to remove the clot and **restore blood flow**. - On the second day of symptom onset, with a fully developed **large infarct** and progressive neurological deterioration due to edema, the brain tissue is likely already irreversibly damaged, making thrombectomy ineffective and potentially harmful due to reperfusion injury.

Q: The following image shows:

Ommaya reservoir. ***Ommaya reservoir*** - The image displays an **Ommaya reservoir**, characterized by a **dome-shaped port** connected to a catheter. This device is typically implanted subcutaneously on the scalp and the catheter is placed into a cerebral ventricle. - It is used for repeated access to the **cerebrospinal fluid (CSF)**, primarily for administering chemotherapy directly into the CSF or for drawing CSF samples. *Chemo-port* - A chemo-port (also known as a port-a-cath) is a central venous access device, usually implanted under the skin in the chest, with the catheter tip residing in a large central vein. - While also used for chemotherapy, its structure differs, primarily being a **subcutaneous port** with a catheter ending in the venous system, not directly in brain ventricles like an Ommaya reservoir. *Peripherally inserted Central catheter* - A PICC line is a long, thin tube inserted into a peripheral vein (usually in the arm) and advanced until the tip reaches a large vein in the chest near the heart. - It is used for long-term intravenous access but is not designed for direct access to the cerebrospinal fluid. *Thermo-probe* - A thermo-probe is a device used to measure temperature, often in a medical context for monitoring body temperature during surgery or critical care. - Its design is entirely different, typically consisting of a sensor at the tip of a flexible wire, without the distinct reservoir and catheter structure seen in the image.

Question 1

A woman presents 4 days after a laparotomy with complete wound dehiscence. After prescribing antibiotics the surgeon decides to suture the wound. Which of these suture materials should he use?

Accepted Answer

Ethilon

Answer

Vicryl

Answer

Chromic catgut

Answer

Mersilk

Question 2

The method of ulcer healing shown below generates a pressure of: (Recent NEET Pattern 2016-17)

Accepted Answer

Minus 125 mm Hg

Answer

Minus 100 cm of water

Answer

Plus 100 cm of water

Answer

Plus 125 cm of water

Question 3

Identify the instrument shown in the image:

Accepted Answer

Asepto syringe

Answer

Trocar for tapping hydrocele

Answer

Czerny retractor

Answer

Malecot catheter

Question 4

Which is correct about the suture material shown in the image?

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

It is less reactive

Answer

Derived from cat gut mucosa

Answer

Used for bowel anastomosis

Question 5

Which retractor is shown in the image?

Accepted Answer

Deaver retractor

Answer

Morris retractor

Answer

Langenbeck retractor

Answer

Doyen retractor

Question 6

A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

Derived from catgut

Answer

Non-absorbable

Answer

Absorbed over 3 months

Question 7

The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Accepted Answer

Nyhus Type IIIB

Answer

Nyhus Type I

Answer

Nyhus Type II

Answer

Nyhus Type IIIA

Question 8

The image shows a child with acute lymphoblastic leukemia. Identify the type of catheter shown:

Accepted Answer

Hickman catheter

Answer

Malecot catheter

Answer

Cimino-Brescia catheter

Answer

Peripherally inserted centrally catheter

Question 9

A 60-year-old male presents to the emergency department on the second day of symptom onset with progressive deterioration of consciousness due to large right MCA territory infarct. Which of the following is the most appropriate management? (Image: img-179.jpeg)

Accepted Answer

Decompressive surgery

Answer

Anticoagulation

Answer

Dual antiplatelet therapy

Answer

Mechanical thrombectomy

Question 10

The following image shows:

Accepted Answer

Ommaya reservoir

Answer

Chemo-port

Answer

Peripherally inserted Central catheter

Answer

Thermo-probe

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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