General Surgery Principles Practice Questions

Q: Best solution to be used in hypovolemic shock is:

Ringer's Lactate solution.. ***Ringer's Lactate solution*** - This **isotonic crystalloid solution** is commonly used in hypovolemic shock because its electrolyte composition is similar to that of human plasma. [2] - The **lactate** component is metabolized by the liver to bicarbonate, which helps to buffer acidosis often associated with shock. [2] *Darrow's solution* - Darrow's solution is a **hypertonic solution** containing high concentrations of potassium, primarily used for severe dehydration and significant potassium deficits, not initial fluid resuscitation in hypovolemic shock. - Its high potassium content can be dangerous in patients with **renal impairment** or who are already hyperkalemic. *5% dextrose* - **5% dextrose in water (D5W)** is an initially isotonic solution, but the dextrose is quickly metabolized, making it effectively a hypotonic solution. [2] - It is primarily used to provide **free water** and is not effective for volume expansion in hypovolemic shock as it does not stay in the intravascular space. [2] *0.9% Nacl* - **0.9% normal saline** is an isotonic crystalloid often used for volume resuscitation but has a higher chloride content than plasma, which can lead to **hyperchloremic metabolic acidosis** with large volumes. [1], [2] - While it expands the intravascular space, Ringer's Lactate is often preferred in situations of significant blood loss or acidosis due to its more balanced electrolyte profile and buffering capacity. [2]

Q: For a midline incision in the abdomen, length of suture required is:

4 times the length of incision. ***4 times the length of incision*** - The standard recommendation for interrupted abdominal fascial closure is to use a **suture-to-wound length ratio** of approximately **4:1**. - This ratio ensures sufficient material for adequate fascial apposition, overlapping bites, and knots, which are crucial for preventing wound dehiscence. *3 times the length of incision* - A 3:1 suture-to-wound ratio might be insufficient for secure fascial closure, potentially leading to increased tension on the suture lines and a **higher risk of dehiscence**. - This ratio could be considered for very specific continuous closure techniques, but it's generally not recommended for standard interrupted closures. *2 times the length of incision* - A 2:1 ratio is generally considered **inadequate** for most fascial closures, especially in the abdomen. - This ratio would likely result in insufficient suture material, leading to very large bites and an insecure closure, significantly increasing the risk of **wound dehiscence** and **herniation**. *5 times the length of incision* - While it ensures enough material, a 5:1 ratio suggests using **excessive suture material** which might extend operating time. - Using significantly more suture than necessary offers no proven benefit in terms of wound security and can sometimes introduce more foreign material into the wound.

Q: Whitehead's varnish in gauze is used to arrest bleeding from:

Bleeding from bone.. ***Bleeding from bone*** - **Whitehead's varnish** contains **iodoform and benzoin** (iodoform in benzoin compound tincture), which have an **astringent and antiseptic** effect. - When applied to bleeding bone surfaces, it helps to **coagulate proteins** and promote **mechanical tamponade**, thereby arresting bleeding. - Commonly used in **oral and maxillofacial surgery** to control bleeding from bone cavities. *Bleeding from capillaries* - Capillary bleeding is usually **minor and self-limiting**, often controlled by **direct pressure** or simple absorbents. - Whitehead's varnish is typically reserved for more persistent bleeding from bony surfaces, not superficial capillaries. *Bleeding from skin* - Skin bleeding generally responds well to **direct pressure, simple dressings**, or **topical coagulants** if needed. - Whitehead's varnish is not a primary therapeutic agent for cutaneous bleeding; its formulation is specifically aimed at managing bone bleeding. *All of the options* - While it might theoretically have some effect on other types of bleeding, its **primary and specifically indicated use** is for bleeding from bone. - Applying it to all forms of bleeding would be **ineffective** or **inappropriate** given more conventional and targeted treatments available for capillary and skin bleeding.

Q: Abdominal compartment syndrome is characterized by the following except:

Oliguria due to ureter obstruction. ***Oliguria due to ureter obstruction*** - **Oliguria** in abdominal compartment syndrome is primarily due to **renal hypoperfusion** caused by increased intra-abdominal pressure compressing renal vasculature and reducing kidney blood flow, **not ureter obstruction**. - Increased intra-abdominal pressure can also cause direct **renal parenchymal compression** and activation of neurohormonal mechanisms, leading to reduced urine output. *Hypotension due to decrease in venous return* - Increased intra-abdominal pressure compresses the **inferior vena cava**, leading to reduced **venous return** to the heart. - This decreased preload results in a lower cardiac output and subsequent **hypotension**. - This is a **true characteristic** of abdominal compartment syndrome. *Hypoxia due to increased peak inspiratory pressure* - Elevated intra-abdominal pressure pushes the diaphragm upwards, leading to reduced **lung compliance** and **tidal volume**. - This increases the **peak inspiratory pressure** required to ventilate the lungs and can result in **hypoxia**. - This is a **true characteristic** of abdominal compartment syndrome. *Hypercarbia and respiratory acidosis* - The combination of **diaphragmatic splinting** and **reduced lung compliance** leads to impaired ventilation. - This causes inadequate carbon dioxide excretion, resulting in **hypercarbia** (elevated CO2) and subsequent **respiratory acidosis**. - This is a **true characteristic** of abdominal compartment syndrome.

Q: EUSOL solution used in treatment of venous ulcer contains all except

Sodium hydroxide. ***Sodium hydroxide*** - EUSOL (Edinburgh University Solution of Lime) solution is an antiseptic solution that traditionally contains equal parts of **bleaching powder (chlorinated lime)** and **boric acid**, dissolved in water. - **Sodium hydroxide** is not a component of the standard EUSOL solution formulation. *Boric acid* - **Boric acid** is a key ingredient in EUSOL solution, contributing to its antiseptic and mild astringent properties. - It helps to buffer the solution and enhance its stability. *Calcium hydroxide* - **Calcium hydroxide** is a component of **chlorinated lime**, which is used to generate sodium hypochlorite within the solution. - It is an indirect ingredient, as part of the bleaching powder. *Sodium hypochlorite* - **Sodium hypochlorite** is the active antiseptic agent formed when chlorinated lime reacts with water. - It provides the primary antimicrobial action against bacteria in wounds.

Q: The gold standard for definitive wound coverage in open wounds requiring tissue replacement is:

Skin grafting. ***Skin grafting*** - **Skin grafting** involves transplanting healthy skin from one area of the body to another to cover a wound. This is the **gold standard for definitive wound coverage** in open wounds requiring tissue replacement. - It provides **viable, vascularized tissue** that can permanently integrate with the wound bed, making it superior for large or deep wounds where other methods are insufficient. - Both **split-thickness skin grafts (STSG)** and **full-thickness skin grafts (FTSG)** are used depending on the wound characteristics and requirements. *Traditional dressings* - While essential for initial wound care, **traditional dressings (e.g., gauze)** primarily provide a protective barrier and absorb exudate, but they do not contribute to definitive tissue replacement for open wounds. - They are considered a staple for **temporary management** and healing by secondary intention, but not the "gold standard" for *replacing* lost tissue. *Synthetic skin substitutes* - These are **engineered materials** designed to mimic some functions of skin, providing a temporary or permanent cover. - While useful for **wound healing acceleration** or as a temporary bridge for grafting, they are not universally considered the **gold standard for definitive tissue replacement** in all open wounds as they may lack full integration or viability compared to native tissue. *Biological dressings* - These include materials derived from human or animal tissue (e.g., **allografts, xenografts**) that serve as temporary wound coverings. - Biological dressings help **prepare the wound bed** and promote healing but are often resorbed or rejected and typically need to be replaced by a permanent solution like skin grafting for definitive closure.

Q: A 43-year-old window cleaner fell off a scaffold. He sustained an open wound on the right leg. Debridement was carried out in the emergency department, and the edges of the wound were left open. Which factor is least likely to inhibit wound contraction?

Transforming growth factor β. ***Transforming growth factor β*** - **TGF-β** is a potent **pro-fibrotic cytokine** that plays a crucial role in promoting wound contraction and fibrosis by stimulating **fibroblast proliferation**, **myofibroblast differentiation**, and **collagen synthesis**. - Its presence and activity would *enhance* rather than inhibit wound contraction, making it the **least likely factor to inhibit** this process. - In wound healing, TGF-β is essential for the contraction phase and tissue remodeling. *Radiation* - **Ionizing radiation** can damage cells, including **fibroblasts** and **myofibroblasts**, which are essential for wound contraction. - This cellular damage and reduction in viable cells can significantly **impair** the contractile forces within the wound. - Radiation therapy is a known factor that inhibits wound healing and contraction. *Full-thickness skin graft* - A **full-thickness skin graft** introduces a complete layer of skin, including the dermis, into the wound. - The presence of the **dermis** within the graft provides a structural barrier and helps to **anchor the wound edges**, thereby reducing the tendency for contraction. - In contrast, **split-thickness grafts** allow more wound contraction due to less dermal tissue. *Cytolytic drug* - **Cytolytic drugs** are designed to kill cells, and if applied to a wound, they would destroy **fibroblasts** and **myofibroblasts**. - The destruction of these critical cells would directly **inhibit** the cellular machinery responsible for pulling the wound edges together, hence preventing contraction. - These drugs impair the proliferative phase of wound healing.

Q: For a lacerated wound, delayed primary suturing is done within:

48 hr. ***48 hr*** - **Delayed primary closure (DPC)** is typically performed **between 48 hours and 7 days** after the initial injury, with **48 hours representing the earliest threshold** for this technique. - At 48 hours, the wound has passed the acute inflammatory phase, bacterial load has been reduced through initial wound care, and the tissue can be assessed for readiness to close. - This method is used for **contaminated or potentially infected wounds** where immediate closure would risk infection, allowing time for wound cleaning and monitoring. - While optimal DPC is often performed at **3-5 days**, 48 hours marks the transition from primary to delayed primary closure. *24 hr* - This timeframe represents **primary closure**, where clean, uncontaminated wounds are sutured immediately or within the first 24 hours of injury. - At 24 hours, contaminated wounds have not had sufficient time for bacterial load reduction and inflammatory response assessment. *36 hr* - While 36 hours represents a delay from immediate closure, it falls short of the **minimum 48-hour threshold** typically required for delayed primary closure. - This intermediate timeframe does not allow adequate wound assessment and bacterial load reduction. *50 hr* - Although 50 hours falls within the DPC window (48 hours to 7 days), the question asks for the timeframe within which DPC is done, and **48 hours is the established earliest/minimum threshold**. - While DPC can certainly be performed at 50 hours, 48 hours is the standard benchmark cited in surgical literature as the beginning of the DPC window.

Q: Which of the following muscles is cut in posterolateral thoracotomy?

Latissimus dorsi. ***Latissimus dorsi*** - The **latissimus dorsi** is the **largest muscle divided** during a standard posterolateral thoracotomy incision. - It is the **most superficial** of the divided muscles and is routinely cut to allow access to the deeper structures and ribs required for entry into the thoracic cavity. - This is the **primary muscle** identified with this surgical approach. *Serratus anterior* - The **serratus anterior** is also typically **divided** (along with latissimus dorsi) in a posterolateral thoracotomy. - However, latissimus dorsi is considered the **more characteristic** muscle of this approach due to its larger size and more superficial position. - Preservation when possible is important for shoulder function (scapular protraction and superior rotation). *Rhomboids* - The **rhomboid muscles** (major and minor) lie deeper, beneath the trapezius, and are **not typically cut** in a standard posterolateral thoracotomy. - They remain protected and are involved in **scapular retraction** and downward rotation. *Pectoralis major* - The **pectoralis major** muscle is a large chest muscle located **anteriorly** and is **not involved** in a posterolateral thoracotomy approach. - This muscle is relevant in anterior thoracotomy approaches, where it's involved in **adduction, medial rotation**, and flexion of the humerus.

Question 1

Best solution to be used in hypovolemic shock is:

Accepted Answer

Ringer's Lactate solution.

Answer

Darrow's solution.

Answer

5% dextrose.

Answer

0.9% Nacl.

Question 2

For a midline incision in the abdomen, length of suture required is:

Accepted Answer

4 times the length of incision

Answer

3 times the length of incision

Answer

2 times the length of incision

Answer

5 times the length of incision

Question 3

Whitehead's varnish in gauze is used to arrest bleeding from:

Accepted Answer

Bleeding from bone.

Answer

Bleeding from capillaries.

Answer

Bleeding from skin.

Answer

All of the options.

Question 4

Abdominal compartment syndrome is characterized by the following except:

Accepted Answer

Oliguria due to ureter obstruction

Answer

Hypotension due to decrease in venous return

Answer

Hypoxia due to increased peak inspiratory pressure

Answer

Hypercarbia and respiratory acidosis

Question 5

EUSOL solution used in treatment of venous ulcer contains all except

Accepted Answer

Sodium hydroxide

Answer

Boric acid

Answer

Calcium hydroxide

Answer

Sodium hypochlorite

Question 6

The gold standard for definitive wound coverage in open wounds requiring tissue replacement is:

Accepted Answer

Skin grafting

Answer

Traditional dressings

Answer

Synthetic skin substitutes

Answer

Biological dressings

Question 7

A 43-year-old window cleaner fell off a scaffold. He sustained an open wound on the right leg. Debridement was carried out in the emergency department, and the edges of the wound were left open. Which factor is least likely to inhibit wound contraction?

Accepted Answer

Transforming growth factor β

Answer

Radiation

Answer

Full-thickness skin graft

Answer

Cytolytic drug

Question 8

For a lacerated wound, delayed primary suturing is done within:

Accepted Answer

48 hr

Answer

24 hr

Answer

36 hr

Answer

50 hr

Question 9

A patient with grossly contaminated wound presents 12 hours after an accident. His wound should be managed by -

Accepted Answer

Thorough cleaning with debridement of all dead and devitalised tissue without primary closure

Answer

Primary closure over a drain

Answer

Covering the defect with split skin graft after cleaning

Answer

Thorough cleaning and primary repair

Question 10

Which of the following muscles is cut in posterolateral thoracotomy?

Accepted Answer

Latissimus dorsi

Answer

Serratus anterior

Answer

Rhomboids

Answer

Pectoralis major

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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