General Surgery Principles Practice Questions

Q: Which of the following is the best treatment for Grade II abdominal hypertension?

Restrictive fluid resuscitation. ***Restrictive fluid resuscitation*** - **Grade II abdominal hypertension** is defined by an intra-abdominal pressure (IAP) between **16-20 mmHg**. At this stage, conservative measures are prioritized over invasive procedures. - **Restrictive fluid resuscitation** involves carefully managing fluid intake to minimize edema and prevent further increases in intra-abdominal pressure (IAP), which can exacerbate symptoms. This is a key non-operative intervention for managing intra-abdominal hypertension. *Immediate decompression* - **Immediate decompression** (e.g., through decompressive laparotomy) is typically reserved for **Grade III or IV abdominal hypertension** or when there is evidence of organ dysfunction due to the elevated pressure. - Decompression is an invasive procedure with associated risks and is not indicated as a first-line treatment for Grade II hypertension where less invasive medical management can be effective. *Normovolemic resuscitation* - **Normovolemic resuscitation** aims to maintain a normal blood volume. While important in trauma, it does not specifically address the underlying issue of increasing IAP in **abdominal hypertension**. - Excessive fluid administration, even to maintain normovolemia, can contribute to interstitial edema and worsen intra-abdominal pressure. *Laparotomy* - **Laparotomy** (surgical opening of the abdomen) is considered a last resort for **abdominal compartment syndrome (ACS)**, which is the most severe form, or when non-operative measures have failed. - For **Grade II abdominal hypertension**, a less invasive approach is preferred. Surgical intervention carries significant risks and is not typically indicated at this stage.

Q: Amputation is often not required in:

Chronic osteomyelitis. ***Chronic osteomyelitis*** - While chronic osteomyelitis can be severe, advancements in **antibiotic therapy**, **surgical debridement**, and **reconstructive procedures** often allow for limb salvage. - The goal of treatment is to eradicate infection and preserve function, making amputation a last resort when other methods fail to control infection or restore viability. *Buerger's* - **Buerger's disease** (thromboangiitis obliterans) is characterized by inflammation and thrombosis of small and medium-sized arteries and veins, primarily in the limbs, leading to severe ischemia and gangrene. - Due to progressive vascular damage and frequent lack of effective medical treatment for advanced stages, **amputation is often required** to remove necrotic tissue and manage intractable pain. *diabetic gangrene* - **Diabetic gangrene** results from a combination of **peripheral neuropathy**, **peripheral arterial disease**, and **infection**, leading to tissue death, particularly in the feet. - The compromised blood supply and impaired wound healing in diabetic patients make these lesions prone to rapid progression and severe infection, with **amputation frequently necessary** to prevent systemic sepsis and death. *Gas gangrene* - **Gas gangrene** is a rapidly progressive and life-threatening infection caused by *Clostridium* species, which produce toxins and gas within tissues. - Due to its aggressive and destructive nature, requiring immediate and extensive surgical debridement often involving **amputation of the affected limb** to remove all infected tissue and prevent widespread systemic toxicity.

Q: Incomplete casting can be due to:

All of the options.. ***All of the options.*** - All listed factors—**low casting pressure**, **insufficient venting**, and an **inadequate or too small sprue**—can prevent molten metal from completely filling the mold cavity during casting. - Incomplete casting is a common issue in foundry practice, and addressing these collective issues is crucial for achieving high-quality castings. *Low casting pressure.* - **Low casting pressure** means the molten metal is not pushed into the mold cavity with enough force to completely fill all parts. - This can lead to **voids** or **unfilled sections** in the final cast object. *Insufficient venting.* - When there is **insufficient venting**, trapped gases within the mold cannot escape as the molten metal fills the cavity. - This results in **incomplete filling** and porosity, as the gas pockets block the flow of metal. *Inadequate or too small sprue.* - A **sprue** that is either **inadequate** in design or **too small** in diameter restricts the flow of molten metal into the mold. - This limitation in metal flow can prevent the mold from being entirely filled, leading to incomplete casting.

Q: Most common type of shock in emergency room is

Hypovolaemic. ***Hypovolaemic*** - **Hypovolemic shock** is the most frequent type of shock encountered in emergency rooms due to its association with a wide range of common conditions, such as **hemorrhage** (trauma, gastrointestinal bleeding) and severe dehydration. - It results from a significant **loss of circulating blood volume**, leading to inadequate tissue perfusion [2]. *Obstructive* - **Obstructive shock** occurs when there is a physical obstruction to blood flow, such as in **pulmonary embolism** [1] or **cardiac tamponade** [3]. - While serious, these conditions are less common overall in the emergency setting compared to causes of hypovolemia. *Cardiogenic* - **Cardiogenic shock** is caused by the heart's inability to pump sufficient blood, typically due to **myocardial infarction** [3] or severe heart failure. - Although life-threatening, it is less common than hypovolemic shock as a primary presenting etiology in the emergency department. *Neurogenic* - **Neurogenic shock** is a distributive shock caused by a severe injury to the **central nervous system**, leading to loss of sympathetic tone and widespread vasodilation. - While it can be seen in severe trauma, it is a specific and less common form of shock compared to hypovolemia.

Q: Primary closure of incised wounds must be done within

6 hrs. ***6 hrs*** - **Primary closure** of incised wounds is generally recommended within **6 hours** of injury to minimize the risk of infection. - This timeframe allows for wound cleaning and closure before significant bacterial colonization occurs. *12 hrs* - Closing wounds at **12 hours** or later significantly increases the risk of **wound infection** due to bacterial proliferation. - Delayed closure beyond this period is often managed with **delayed primary closure** or secondary intention healing. *2 hrs* - While closure within **2 hours** is ideal, a slightly longer window of up to 6 hours is still considered safe for primary closure. - The 2-hour mark is not a strict upper limit for all wounds. *4 hrs* - **4 hours** is within the acceptable window for primary closure, but the more commonly cited and safe upper limit for most clean wounds is 6 hours. - There is no significant clinical benefit of closing strictly within 4 hours compared to 6 hours for most healthy individuals and clean wounds.

Q: A 55-year-old male presents with a painful bulge in the groin that becomes more prominent when standing. Physical examination confirms an inguinal hernia. What is the definitive treatment?

Hernioplasty. ***Hernioplasty*** - **Hernioplasty** (mesh repair) is the definitive surgical treatment for inguinal hernia, involving either open (Lichtenstein) or laparoscopic (TEP/TAPP) approaches using mesh to reinforce the abdominal wall. - This procedure addresses the underlying anatomical defect, preventing complications such as **incarceration** or **strangulation**, which can be life-threatening. - Modern mesh-based repair has lower recurrence rates compared to traditional tissue repair (herniorrhaphy). *Truss application* - A **truss** is a supportive device that applies external pressure to the hernia site to keep it reduced. - It is considered a temporary measure to manage symptoms and is **not a definitive treatment** as it does not repair the structural defect. *Observation* - **Observation** alone may be considered in asymptomatic or minimally symptomatic patients with reducible hernias (watchful waiting). - However, this patient is **symptomatic** (painful bulge), making surgical repair the preferred definitive approach to prevent complications like **incarceration**. *Antibiotic therapy* - **Antibiotic therapy** is used to treat bacterial infections. - An **inguinal hernia** is a structural defect, not an infection, and therefore antibiotics are not a relevant treatment.

Q: A central line is inserted into a patient for chemotherapy administration. What is the most appropriate position for the tip of the catheter?

Superior vena cava. ***Superior vena cava*** - The **superior vena cava (SVC)** is the ideal placement for a central line tip, approximately at the junction of the SVC and the **right atrium**. - This position ensures rapid dilution of infusates, such as **chemotherapeutic agents**, minimizing vascular irritation and the risk of vein thrombosis or damage. *Pulmonary artery* - Advancing a central line into the **pulmonary artery** is typically done for **pulmonary artery catheterization** (e.g., Swan-Ganz catheter) to monitor hemodynamic pressures, not for routine chemotherapy. - Placement here would carry a significant risk of **pulmonary artery perforation** or obstruction. *Inferior vena cava* - The **inferior vena cava (IVC)** is accessed via lower extremity veins (e.g., femoral vein) and is not generally preferred for chemotherapy administration due to higher rates of **deep vein thrombosis** and less optimal dilution compared to SVC placement. - Catheter tips placed in the IVC are primarily for filters or infusions in patients with limited upper body access. *Right atrium* - While close to the SVC, positioning the catheter tip directly within the **right atrium** is generally avoided due to the risk of cardiac irritation, leading to **arrhythmias** or local damage. - The turbulent flow within the atrium can also contribute to **thrombus formation** around the catheter tip.

Q: During a surgical procedure, the surgeon decides to close the wound with an absorbable suture. Which of the following suture materials is the most appropriate?

Vicryl. ***Vicryl*** - **Vicryl** is a synthetic absorbable suture composed of **polyglactin 910**, known for its predictable absorption profile. - It maintains good tensile strength for several weeks and is completely hydrolyzed within **56-70 days**, making it suitable for internal closures where temporary support is needed. *Nylon* - **Nylon** (polyamide) is a **non-absorbable**, monofilament suture material known for its high tensile strength and minimal tissue reactivity. - It is primarily used for **skin closure** and other applications where permanent strength retention is desired, not for absorbable closure. *Silk* - **Silk** is a **non-absorbable**, braided natural fiber suture that causes a significant tissue reaction due to its proteinaceous nature. - Although it feels soft and handles well, its strength degrades over time and it is considered a **historical non-absorbable** rather than a predictably absorbable material. *Prolene* - **Prolene** (polypropylene) is a **non-absorbable**, monofilament suture with excellent tensile strength and very low tissue reactivity. - It is ideal for **vascular anastomoses** and permanent implants where long-term support and minimal inflammation are crucial, not for absorbable closure.

Q: Which suture material is most appropriate for closing the skin in a contaminated wound to minimize infection risk?

Nylon. ***Nylon*** - **Nylon** is a **monofilament**, non-absorbable suture material, which means it has a smooth surface and does not harbor bacteria as easily as braided sutures. - Its non-absorbable nature ensures long-term wound support while minimizing the risk of a foreign body reaction and subsequent infection in a contaminated field. *Vicryl* - **Vicryl (polyglactin 910)** is a **braided, absorbable suture** that can potentially harbor bacteria within its interstices, making it less suitable for contaminated wounds due to increased infection risk. - Being absorbable, it loses tensile strength over time, which may not be ideal for skin closure where sutures are typically removed after wound healing. *Silk* - **Silk** is a **braided, non-absorbable suture** known for its high tissue reactivity and capillarity, meaning it can absorb fluids and potentially draw bacteria into the wound, increasing infection risk. - Its multifilament nature also makes it more prone to bacterial colonization compared to monofilament sutures. *Catgut* - **Catgut** is a **natural, absorbable suture** derived from animal intestines, which elicits a significant inflammatory response and is rapidly degraded by tissue enzymes. - This rapid absorption and strong inflammatory reaction make it unsuitable for skin closure, especially in contaminated wounds, due to heightened infection potential and unreliable wound support.

Q: Which type of hernia is most likely to result in bowel strangulation?

Femoral hernia. ***Femoral hernia*** - **Femoral hernias** have a higher risk of strangulation due to their **narrow neck** and rigid boundaries (inguinal ligament, Cooper's ligament, lacunar ligament). - The tight space through the femoral canal makes incarceration and subsequent strangulation more likely, leading to a compromise in blood supply. *Inguinal hernia* - While **inguinal hernias** are the most common type, their neck is generally wider than that of femoral hernias, leading to a lower proportionate risk of strangulation. - They can be either direct or indirect, with the latter passing through the deep inguinal ring and along the inguinal canal. *Umbilical hernia* - **Umbilical hernias** occur at the umbilicus and are common in infants, often resolving spontaneously. In adults, they are typically acquired. - They have a relatively wide defect, which makes strangulation less common compared to femoral hernias, although it can still occur, especially with larger defects. *Incisional hernia* - **Incisional hernias** develop at the site of a previous surgical incision, often due to inadequate wound healing or increased intra-abdominal pressure. - They typically have a wide defect, which reduces the likelihood of strangulation, though larger hernias can still incarcerate.

Question 1

Which of the following is the best treatment for Grade II abdominal hypertension?

Accepted Answer

Restrictive fluid resuscitation

Answer

Immediate decompression

Answer

Normovolemic resuscitation

Answer

Laparotomy

Question 2

Amputation is often not required in:

Accepted Answer

Chronic osteomyelitis

Answer

Buerger's

Answer

Diabetic gangrene

Answer

Gas gangrene

Question 3

Incomplete casting can be due to:

Accepted Answer

All of the options.

Answer

Low casting pressure.

Answer

Insufficient venting.

Answer

Inadequate or too small sprue.

Question 4

Most common type of shock in emergency room is

Accepted Answer

Hypovolaemic

Answer

Obstructive

Answer

Cardiogenic

Answer

Neurogenic

Question 5

Primary closure of incised wounds must be done within

Accepted Answer

6 hrs

Answer

12 hrs

Answer

2 hrs

Answer

4 hrs

Question 6

A 55-year-old male presents with a painful bulge in the groin that becomes more prominent when standing. Physical examination confirms an inguinal hernia. What is the definitive treatment?

Accepted Answer

Hernioplasty

Answer

Truss application

Answer

Observation

Answer

Antibiotic therapy

Question 7

A central line is inserted into a patient for chemotherapy administration. What is the most appropriate position for the tip of the catheter?

Accepted Answer

Superior vena cava

Answer

Inferior vena cava

Answer

Pulmonary artery

Answer

Right atrium

Question 8

During a surgical procedure, the surgeon decides to close the wound with an absorbable suture. Which of the following suture materials is the most appropriate?

Accepted Answer

Vicryl

Answer

Nylon

Answer

Silk

Answer

Prolene

Question 9

Which suture material is most appropriate for closing the skin in a contaminated wound to minimize infection risk?

Accepted Answer

Nylon

Answer

Silk

Answer

Catgut

Answer

Vicryl

Question 10

Which type of hernia is most likely to result in bowel strangulation?

Accepted Answer

Femoral hernia

Answer

Inguinal hernia

Answer

Umbilical hernia

Answer

Incisional hernia

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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