General Surgery Principles Practice Questions

Q: All of the following statements are true for keloids EXCEPT:

True keloid does not spread into surrounding tissue. ***True keloid does not spread into surrounding tissue*** - This statement is **incorrect** as a defining characteristic of keloids is their tendency to **spread beyond the original wound boundaries**, invading surrounding healthy tissue. - This expansive growth differentiates keloids from hypertrophic scars, which remain confined to the site of injury. *The maturation and stabilization of the collagen fibrils is inhibited* - This statement is **true**. In keloids, there is an impairment in the normal maturation process of collagen, leading to an accumulation of **immature, disorganized collagen fibrils**. - This abnormal collagen synthesis and degradation contribute to the excessive and persistent fibrosis characteristic of keloids. *It is rarely seen in white skinned persons and is more common over the sternum* - This statement is **true**. Keloids are more prevalent in individuals with **skin of color (e.g., African, Hispanic, and Asian descent)** and are less common in Caucasians. - Common locations for keloids include the **sternum**, earlobes, shoulders, and upper back, areas under significant skin tension. *True keloid continues to become worse even after one year* - This statement is **true**. Unlike hypertrophic scars which may regress over time, keloids tend to be **persistent and progressive**, often continuing to grow and worsen in size and appearance even years after the initial injury. - They typically do not resolve spontaneously and may even recur after excision.

Q: All of the following are congenital sinuses except:

Pilonidal. ***Pilonidal*** - A **pilonidal sinus** is an acquired condition, usually developing after puberty, linked to **hair follicles** and repeated trauma or pressure in the **sacrococcygeal region**. - It is not present at birth but rather develops over time due to **local trauma**, infection, and foreign body reaction to hair. *Coccygeal* - A **coccygeal dimple** or sinus is a **congenital pit** or tract located over the coccyx. - While sometimes referred to as coccygeal sinuses, these are developmental defects present **from birth**. *Urachal sinus* - An **urachal sinus** is a **congenital anomaly** resulting from incomplete closure of the **urachus**, a fetal remnant connecting the bladder to the umbilicus. - This condition is present at birth, often manifesting with **umbilical discharge**. *Pre auricular* - A **preauricular sinus** is a **congenital malformation** of the outer ear, typically appearing as a small pit or opening near the front of the ear. - It arises from incomplete fusion of the **auricular hillocks** during embryonic development.

Q: The main principle regarding removal of drain after surgery is

Drain should be removed as soon as it is no longer required. ***Drain should be removed as soon as it is no longer required*** - The primary principle of drain management is to remove them promptly once their purpose has been served. **Prolonged drain placement** increases the risk for complications such as **infection** and pain. - The decision to remove a drain is based on the **volume and character of the drainage**, patient comfort, and the overall clinical picture, ensuring that the benefit of removal outweighs the risk of fluid accumulation. *Keep drains as long as possible to prevent complications* - This statement is incorrect as keeping drains for an extended period significantly increases the risk of **drain infection**, **increased pain**, and potential **tract formation** that could lead to persistent fistula. - While drains can prevent early complications like **hematoma** or **seroma**, their long-term presence introduces new risks that outweigh initial benefits. *Drains kept for colo-rectal anastomosis should be removed within 2 days as they can cause complications* - The timing for drain removal after **colorectal anastomosis** is guided by clinical judgment, usually when output is minimal and clear, and there is no evidence of anastomotic leak. There is **no universal rule** that they must be removed within 2 days. - Premature removal in high-risk anastomoses could lead to **unrecognized leaks** and subsequent abdominal collections, while prolonged placement beyond necessity also carries risks. *Suction drains can be removed early* - The type of drain (suction vs. gravity) does not dictate early removal, but rather the **volume and nature of fluid collected** and the specific surgical context. - While **suction drains** are highly effective in removing fluid, their removal timing is still based on clinical criteria specific to the patient's recovery, not solely on the drain type.

Q: A 60 year old lady had a pyothorax which was treated with an intercostal chest drain. After two days, the meniscus of the fluid in the tube was not swinging during her respiratory process. What could be the likely problem?

Chest drain blockage. ***Chest drain blockage*** - A lack of **meniscus swinging** indicates that the chest drain is no longer effectively communicating with the pleural space, often due to a **blockage** (e.g., blood clot, fibrin). - This prevents the normal pressure changes during respiration from being transmitted to the fluid in the drain tube. *Water seal not proper* - An improper **water seal** (e.g., leak in the system, insufficient water) would typically lead to continuous **air bubbling** in the water seal chamber, not necessarily a lack of meniscus swing. - While it can affect drainage, it's not the primary reason for absent respiratory fluctuations. *No fluid in the chest drain bag* - The *absence of fluid in the collection bag* is a sign of *resolved drainage* or a *blocked tube*, but it does not directly explain the *lack of meniscus swing* in the water seal chamber. - The meniscus swing reflects pressure changes in the pleural space, not the volume in the collection bag. *High atmospheric pressure* - **Atmospheric pressure** changes are generalized and affect the entire system, not just the connection between the pleural space and the chest drain. - It would not selectively eliminate the respiratory fluctuation of the meniscus.

Q: Untidy wounds are characterised by which of the following? 1. Crushed or avulsed tissues 2. Contaminated wound 3. Devitalised tissue 4. No loss of tissue

1, 2 and 3. ***1, 2 and 3*** - **Untidy wounds**, often resulting from high-energy trauma, are defined by the presence of **crushed or avulsed tissues**, **contamination**, and **devitalized tissue**. - These characteristics make the wound more complex to manage and prone to complications like infection. *1, 2, 3 and 4* - This option incorrectly includes "no loss of tissue" (option 4) as a characteristic of untidy wounds. **Untidy wounds** frequently involve **tissue loss**, making this statement contradictory to their definition. - The presence of **crushed or avulsed tissues** inherently suggests some degree of tissue damage or loss. *1, 2 and 4* - This option incorrectly states that "no loss of tissue" is a characteristic of untidy wounds. In reality, **untidy wounds** are often associated with significant **tissue destruction and loss**. - **Crushed and avulsed tissues** are direct indicators of tissue damage and potential loss. *2, 3 and 4* - This option incorrectly omits "crushed or avulsed tissues" (option 1), which is a cardinal feature of untidy wounds. It also incorrectly includes "no loss of tissue" (option 4). - While **contamination** and **devitalized tissue** are hallmarks of untidy wounds, the absence of crushed/avulsed tissue and the idea of no tissue loss are inaccurate.

Q: Which of the following are types of wound healing? 1. Primary Intention 2. Secondary Intention 3. Tertiary Intention 4. Quaternary Intention

1, 2 and 3. ***1, 2 and 3*** - These options correctly identify the three recognized types of **wound healing** in surgical practice. - **Primary intention (healing by first intention)**: Clean wounds with approximated edges, minimal tissue loss, heals with minimal scarring (e.g., surgical incisions). - **Secondary intention (healing by second intention)**: Wounds with significant tissue loss that heal by granulation tissue formation, wound contraction, and epithelialization (e.g., pressure ulcers, large traumatic wounds). - **Tertiary intention (delayed primary closure)**: Contaminated wounds initially left open for 3-5 days, then closed after infection risk decreases. *1, 2 and 4* - This option incorrectly includes **"Quaternary Intention,"** which is **not a recognized classification** in wound healing. - Only primary, secondary, and tertiary intention are standard types described in surgical textbooks. *2, 3 and 4* - This option omits **"Primary Intention,"** the most common type of wound healing for clean surgical incisions. - It also incorrectly includes "Quaternary Intention," which does not exist in wound healing classification. *1, 3 and 4* - This option omits **"Secondary Intention,"** a crucial healing process for wounds with substantial tissue loss that cannot be primarily closed. - "Quaternary Intention" is not a valid wound healing type and represents a distractor in this question.

Q: The following are features of hypovolemic shock except:

Bradycardia. ***Bradycardia*** - Hypovolemic shock typically causes **tachycardia** (increased heart rate) as a compensatory mechanism to maintain cardiac output in the face of reduced blood volume [1]. - **Bradycardia** is generally not a feature of hypovolemic shock unless there are confounding factors or severe terminal stages. *Acidosis* - **Lactic acidosis** is a common feature of hypovolemic shock due to tissue hypoperfusion causing anaerobic metabolism [2]. - Reduced blood flow leads to inadequate oxygen delivery, forcing cells to produce lactic acid. *Oliguria* - **Oliguria** (decreased urine output) occurs in hypovolemic shock as the kidneys attempt to conserve fluid due to reduced renal perfusion. - The body prioritizes blood flow to vital organs, leading to decreased kidney function and urine production. *Low Blood Pressure* - **Hypotension** (low blood pressure) is a hallmark of shock, including hypovolemic shock, resulting from a significant reduction in circulating blood volume [1]. - The decrease in blood volume directly reduces venous return, stroke volume, and ultimately, systemic blood pressure.

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.

Question 1

All of the following statements are true for keloids EXCEPT:

Accepted Answer

True keloid does not spread into surrounding tissue

Answer

The maturation and stabilization of the collagen fibrils is inhibited

Answer

It is rarely seen in white skinned persons and is more common over the sternum

Answer

True keloid continues to become worse even after one year

Question 2

All of the following are congenital sinuses except:

Accepted Answer

Pilonidal

Answer

Coccygeal

Answer

Urachal sinus

Answer

Preauricular

Question 3

The main principle regarding removal of drain after surgery is

Accepted Answer

Drain should be removed as soon as it is no longer required

Answer

Keep drains as long as possible to prevent complications

Answer

Drains kept for colo-rectal anastomosis should be removed within 2 days as they can cause complications

Answer

Suction drains can be removed early

Question 4

A 60 year old lady had a pyothorax which was treated with an intercostal chest drain. After two days, the meniscus of the fluid in the tube was not swinging during her respiratory process. What could be the likely problem?

Accepted Answer

Chest drain blockage

Answer

Water seal not proper

Answer

No fluid in the chest drain bag

Answer

High atmospheric pressure

Question 5

In Hernia repair, polypropylene suture is used because

Accepted Answer

It is a synthetic monofilament non-absorbable suture with low tissue reaction and high tensile strength

Answer

It is a synthetic monofilament undyed absorbable suture with high tissue reaction and low tensile strength

Answer

It is a synthetic monofilament undyed non absorbable suture with high tissue reaction and which degrades at 15-20% per year

Answer

It is a synthetic braided dyed absorbable suture with low tissue reaction and high tensile strength

Question 6

Which one of the following regarding absorbable meshes is NOT true?

Accepted Answer

They show very good results as collagen deposition is maximum

Answer

They are made of polyglycolic acid fibre

Answer

They are used to buttress sutured repair

Answer

They are used in temporary abdominal wall closure

Question 7

Untidy wounds are characterised by which of the following?

1. Crushed or avulsed tissues
2. Contaminated wound
3. Devitalised tissue
4. No loss of tissue

Accepted Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 8

Which of the following are types of wound healing?

1. Primary Intention
2. Secondary Intention
3. Tertiary Intention
4. Quaternary Intention

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 9

The following are features of hypovolemic shock except:

Accepted Answer

Bradycardia

Answer

Acidosis

Answer

Oliguria

Answer

Low Blood Pressure

Question 10

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

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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