General Surgery Principles Practice Questions

Q: All are absolute indications for amputation except,

Frost bite. ***Frost bite*** - While severe **frostbite** can lead to amputation, it is not an absolute indication as initial management often involves **rapid rewarming**, observation, and conservative measures to preserve tissue. - Amputation is typically considered only after the full extent of tissue damage is clear, and conservative treatments have failed or severe infection develops. *Buerger's gangrene* - **Buerger's disease (thromboangiitis obliterans)** is a progressive inflammatory obliterative disease of small and medium-sized arteries and veins, mainly affecting the limbs. - **Gangrene** in Buerger's disease is often severe and progressive, frequently leading to **autoamputation** or surgical amputation to prevent spread and manage pain. *Gas gangrene* - **Gas gangrene** is a rapidly progressive and life-threatening infection caused by Clostridium species, which produces toxins and gas in tissues. - It necessitates urgent and aggressive treatment, including **radical débridement** or **amputation** to remove infected tissue and prevent sepsis. *Diabetic gangrene* - **Diabetic gangrene** arises from severe peripheral artery disease and neuropathy in diabetic patients, compromising blood supply and sensation. - The compromised blood flow and presence of infection often result in tissue necrosis requiring **amputation** to prevent further spread of infection and systemic complications.

Q: If suture marks are to be avoided, skin sutures should be removed by:

1 week. ***Correct: 1 week*** - Skin sutures are typically removed around **7 days (1 week)** to prevent the formation of **track marks** or permanent scarring along the suture lines. - By this time, sufficient wound healing has occurred for the incision to withstand normal tension, reducing the risk of **dehiscence**. - This timing balances adequate healing with minimal scarring, especially important for cosmetically sensitive areas like the face and neck. *Incorrect: 72 hours* - Removing sutures after only **72 hours (3 days)** is generally too early, as the wound may not have acquired enough tensile strength, increasing the risk of **wound dehiscence**. - While this might minimize suture marks, the primary concern is proper wound healing and closure before suture removal. *Incorrect: 3 weeks* - Leaving sutures in for **3 weeks** is significantly longer than necessary and will almost certainly result in prominent **suture marks** due to epithelialization around the suture material. - Prolonged presence of sutures can also increase the risk of **infection** and foreign body reactions. *Incorrect: 2 weeks* - While sometimes appropriate for areas of high tension or slower healing (e.g., joints, back), **2 weeks** often leads to more noticeable **suture marks** compared to removal at 1 week, particularly in cosmetically sensitive areas. - The goal is to remove sutures as soon as the wound is stable enough to minimize scar formation.

Q: Massive blood transfusion complications include all except -

Hypernatremia. ***Hypernatremia*** - **Massive blood transfusions** typically involve transfusing red blood cells suspended in solutions like normal saline, which is **isotonic** or slightly hypotonic, or solutions containing **citrate**, which is metabolized in the liver to bicarbonate. - Therefore, hypernatremia is **not expected** and, in fact, hyponatremia can occur in some circumstances due to dilution or impaired sodium excretion in severely ill patients. *Hypothermia* - **Refrigerated blood products** are typically stored at 1-6°C; rapid infusion of large volumes of these cold products can significantly lower the patient's core body temperature, leading to **hypothermia**. - Hypothermia can worsen **coagulopathy** and cardiac arrhythmias, which are serious complications in critically ill or hemorrhaging patients. *Hyperkalemia* - As red blood cells are stored, there is a gradual leakage of **potassium** from intracellular to extracellular compartments due to reduced activity of the **Na+/K+ ATPase pump**. - During massive transfusion, the infusion of large volumes of blood with elevated extracellular potassium can lead to significant **hyperkalemia**, especially in patients with impaired renal function. *Hypocalcemia* - **Citrate** is an anticoagulant used in blood storage that binds to **ionized calcium** in the patient's blood, effectively chelating it. - Rapid infusion of large amounts of citrated blood can overwhelm the liver's capacity to metabolize citrate, leading to a significant drop in ionized calcium levels and consequently **hypocalcemia**.

Q: Delayed wound healing is seen in all except-

Hypertension. ***Hypertension*** - While **severe or uncontrolled hypertension** with microvascular complications may theoretically affect tissue perfusion, hypertension **alone is not classically listed** among the primary independent causes of delayed wound healing in standard surgical teaching. - Unlike the other options, hypertension is **not a direct metabolic or local tissue factor** that impairs the wound healing cascade. - The major recognized factors causing delayed wound healing are infection, metabolic disorders (diabetes, malnutrition), malignancy, and immunosuppression—hypertension does not fall into these classical categories. *Diabetes* - **Hyperglycemia** impairs neutrophil function, reduces collagen synthesis, and causes **microvascular disease** that reduces oxygen and nutrient delivery to wounds. - **Diabetic neuropathy** prevents early wound detection, and peripheral vascular disease further compromises healing. - Diabetes is one of the **most important systemic causes** of chronic non-healing wounds. *Infection* - **Bacterial colonization** prolongs the inflammatory phase and prevents progression to proliferation and remodeling. - Pathogens produce **proteases and toxins** that destroy granulation tissue, consume oxygen, and create a hostile wound environment. - Infection is a **local factor** that directly impairs all phases of wound healing. *Malignancy* - **Cancer-associated cachexia** and malnutrition deprive the body of resources needed for tissue repair. - Tumors can **directly invade** wound sites, and cancer treatments (chemotherapy, radiation) impair cellular proliferation and angiogenesis. - Malignancy creates a **systemic catabolic state** unfavorable for healing.

Q: All these are techniques to decrease scarring except:

Late removal of sutures. ***Late removal of sutures*** - **Late removal of sutures** can lead to permanent suture marks and increased scarring, as the epithelial cells grow down the suture track. - This increases the foreign body reaction and the duration of inflammation, ultimately worsening the cosmetic outcome. *Tension-free suturing* - **Tension-free suturing** minimizes mechanical stress on the wound edges, which is crucial for optimal healing and reduced scar formation. - Reduced tension prevents excessive inflammation and tissue ischemia, leading to a flatter, less noticeable scar. *Finer suture materials* - Using **finer suture materials** reduces the amount of foreign body reaction, which is a key factor in scar formation. - Smaller caliber sutures cause less tissue trauma and inflammation, resulting in a more aesthetically pleasing scar. *Debridement* - **Debridement** removes necrotic tissue, foreign bodies, and devitalized tissue from the wound, which are sources of chronic inflammation and impaired healing. - By creating a clean wound bed, debridement promotes healthy granulation tissue and reduces the risk of excessive scarring.

Q: Wound healing is delayed by all of the following EXCEPT?

Debridement. ***Debridement*** - **Debridement** is the medical removal of **dead, damaged, or infected tissue** to improve the healing potential of the remaining healthy tissue. - By removing impediments to healing, debridement actually **facilitates wound healing**, rather than delaying it. *Presence of foreign bodies* - The presence of **foreign bodies** (e.g., dirt, glass, sutures that are causing a reaction) in a wound can act as a **persistent irritant**, leading to chronic inflammation. - This ongoing inflammatory response can **impair the normal progression of wound healing**, often prolonging the healing process. *Trauma* - Severe or repeated **trauma** to a healing wound can disrupt the delicate new tissue formation, such as **granulation tissue** and **epithelium**. - This disruption can lead to **re-injury**, increased inflammation, and a significant delay in the wound's progression through its healing phases. *Excessive tissue manipulation* - **Excessive tissue manipulation** during surgery or wound care can cause further damage to surrounding healthy tissues and blood vessels. - This can increase wound edema, create more dead space, and release inflammatory mediators, all of which can **impede the healing process**.

Q: Best skin disinfectant for central line insertion is?

Chlorhexidine. ***Chlorhexidine*** - **Chlorhexidine gluconate** with alcohol is highly recommended for **skin antisepsis** prior to central venous catheter insertion due to its rapid and persistent antimicrobial activity. - It effectively reduces the risk of **catheter-related bloodstream infections (CRBSIs)** by targeting a broad spectrum of bacteria. *Povidone iodine* - While effective, **povidone iodine** has a slower onset of action and is less persistent compared to chlorhexidine, making it less ideal for this specific procedure. - Its efficacy can be reduced in the presence of organic material, and it may cause **skin irritation** in some patients. *Cetrimide* - **Cetrimide** is a cationic surfactant with antiseptic properties but is generally considered less potent and less widely recommended than chlorhexidine for surgical skin preparation. - It is more commonly found in preparations for cleaning wounds rather than for **major invasive procedures** like central line insertion. *Alcohol* - **Alcohol** provides rapid antisepsis and has a broad spectrum of activity, but its effect is not persistent and it is volatile, leading to quick evaporation. - Its efficacy is enhanced when combined with other agents, such as chlorhexidine, rather than being used alone for **central line insertion**.

Q: False about neurogenic shock

Raised JVP. ***Raised JVP*** - In neurogenic shock, **venous capacitance increases** due to loss of sympathetic tone, leading to **venous pooling in the periphery** and a **decreased central venous pressure** and JVP, not a raised JVP. - A raised JVP usually indicates **fluid overload** or **right heart failure**, which are not primary features of neurogenic shock. *Decreased cardiac output* - The **loss of sympathetic tone** in neurogenic shock leads to widespread vasodilation, which **decreases venous return** and subsequently **reduces preload** [1]. - A decrease in preload directly results in a **reduced stroke volume** and thus a **decreased cardiac output**. *Bradycardia* - Neurogenic shock often results from high spinal cord injury, which **disrupts sympathetic innervation** to the heart while leaving **parasympathetic innervation intact**. - This imbalance causes unopposed vagal activity, leading to **bradycardia** [1]. *Hypotension* - The primary mechanism of hypotension in neurogenic shock is **widespread peripheral vasodilation** due to the loss of **sympathetic vasomotor tone**. - This vasodilation leads to a **significant drop in systemic vascular resistance (SVR)**, causing severe hypotension [1].

Q: The incision in which rectus abdominis muscle is cut transversely is :

Maylard. ***Maylard*** - The **Maylard incision** involves **transverse cutting** (transection) of the **rectus abdominis muscles** to provide excellent pelvic exposure. - This muscle transection allows for superior **lateral access** and is commonly used in **gynecological oncology** procedures. *Kerr* - The **Kerr incision** is a **muscle-splitting technique** where the rectus abdominis muscles are **separated along their fibers**, not cut transversely. - Commonly used for **lower segment Cesarean sections**, preserving muscle integrity while providing adequate access. *Pfannenstiel* - The **Pfannenstiel incision** involves a **transverse skin incision** but the rectus muscles are **retracted laterally** after the anterior sheath is opened, not cut. - The muscles remain intact and are simply **separated in the midline** and moved aside, preserving muscle function and strength. *All of the options* - This is incorrect because **only the Maylard incision** actually involves transverse cutting of the rectus abdominis muscles. - The other incisions either split the muscles along fibers (Kerr) or retract them laterally (Pfannenstiel) without transection.

Question 1

All are absolute indications for amputation except,

Accepted Answer

Frost bite

Answer

Buerger's gangrene

Answer

Gas gangrene

Answer

Diabetic gangrene

Question 2

If suture marks are to be avoided, skin sutures should be removed by:

Accepted Answer

1 week

Answer

72 hours

Answer

3 weeks

Answer

2 weeks

Question 3

Massive blood transfusion complications include all except -

Accepted Answer

Hypernatremia

Answer

Hypothermia

Answer

Hyperkalemia

Answer

Hypocalcemia

Question 4

Delayed wound healing is seen in all except-

Accepted Answer

Hypertension

Answer

Malignancy

Answer

Infection

Answer

Diabetes

Question 5

All these are techniques to decrease scarring except:

Accepted Answer

Late removal of sutures

Answer

Tension-free suturing

Answer

Finer suture materials

Answer

Debridement

Question 6

Wound healing is delayed by all of the following EXCEPT?

Accepted Answer

Debridement

Answer

Presence of foreign bodies

Answer

Trauma

Answer

Excessive tissue manipulation

Question 7

Best skin disinfectant for central line insertion is?

Accepted Answer

Chlorhexidine

Answer

Povidone iodine

Answer

Cetrimide

Answer

Alcohol

Question 8

False about neurogenic shock

Accepted Answer

Raised JVP

Answer

Decreased cardiac output

Answer

Bradycardia

Answer

Hypotension

Question 9

What is the advantage of fiberoptic bronchoscopy over rigid bronchoscopy?

Accepted Answer

Good view

Answer

Better airway control

Answer

Foreign body removal

Answer

In a sick child, it can be passed through an endotracheal tube

Question 10

The incision in which rectus abdominis muscle is cut transversely is :

Accepted Answer

Maylard

Answer

Kerr

Answer

Pfannenstiel

Answer

All of the options

General Surgery Principles — MCQs

General Surgery Principles — MCQs

On this page

Practice by Chapter

Want unlimited practice?