General Surgery Principles Practice Questions

Q: Which of the following sutures has maximum tensile strength and minimum tissue reaction?

Polypropylene. ***Polypropylene*** - Polypropylene is a **non-absorbable monofilament suture** known for its exceptional tensile strength and very low tissue reactivity. - Its **monofilament structure prevents bacterial harborage** and makes it suitable for vascular and cardiovascular surgeries where long-term strength is crucial. *Poliglecaprone* - Poliglecaprone (Monocryl) is a **synthetic absorbable monofilament suture** that offers good tensile strength initially but loses it rapidly over 2-3 weeks. - While it has minimal tissue reaction, its **absorbable nature** prevents it from maintaining long-term tensile strength. *Polyglactin* - Polyglactin (Vicryl) is a **synthetic absorbable braided suture** known for its high initial tensile strength that is retained for 2-3 weeks, with complete absorption in 56-70 days. - Its braided structure can lead to slightly more tissue reaction and a perceived higher risk of infection compared to monofilaments. *Polydioxanone* - Polydioxanone (PDS) is a **synthetic absorbable monofilament suture** that maintains its tensile strength for a longer period than other absorbable sutures (up to 6 weeks) but eventually degrades. - While it has good handling characteristics and low tissue reaction, its **absorbable nature** means it cannot provide permanent wound support.

Q: Prolonged surgery time of vaginal hysterectomy may lead to damage to which of the following nerves?

Peroneal. ***Peroneal*** - Prolonged surgery time in the **lithotomy position**, often used for vaginal hysterectomy, can lead to compression of the **peroneal nerve (specifically the common peroneal nerve)** against the lateral aspect of the fibula head, causing neuropathy. - This compression is often due to sustained pressure from leg supports or stirrups during lengthy procedures. *Obturator* - The **obturator nerve** is located deep within the pelvis and is more commonly injured during dissection in the deep pelvic sidewalls or due to traction during procedures like lymphadenectomy. - Its injury is less typically associated with prolonged positioning during routine vaginal hysterectomy than the peroneal nerve. *Pudendal* - The **pudendal nerve** can be injured during vaginal delivery or prolonged compression from bike seats, but its injury during vaginal hysterectomy in the lithotomy position is less common than peroneal nerve injury. - While prolonged sitting can affect it, the direct compression mechanism seen with leg supports typically targets the peroneal nerve. *Sural* - The **sural nerve** is a sensory nerve in the calf and ankle and is generally not at high risk during vaginal hysterectomy performed in the lithotomy position. - Its common injury mechanisms include trauma to the lower leg or ankle surgery, not typically sustained positioning in the operating room.

Q: For how many weeks do cortisol levels typically remain elevated following a hemorrhage?

2 weeks. ***2 weeks*** - Following a hemorrhage, the **stress response** leads to elevated cortisol levels which typically persist for approximately **2 weeks**. - This sustained elevation is part of the body's adaptive response to trauma, influencing metabolism and immune function. *1 week* - While cortisol levels rise acutely after hemorrhage, they generally remain elevated for a longer period than just **1 week**. - A 1-week duration would be too short for the typical sustained systemic stress response. *3 weeks* - Cortisol levels usually begin to normalize or return closer to baseline around the **2-week** mark, making 3 weeks an overestimation of the typical sustained elevation. - Prolonged elevation beyond 2 weeks might suggest persistent stress or comorbidity, rather than a normal recovery trajectory. *4 weeks* - A 4-week elevation of cortisol following a single hemorrhage is generally considered an unusually prolonged response and is not typical. - Such an extended elevation could indicate a more severe or complicated clinical course, or a different underlying pathology.

Q: Which of the following types of gangrene is least likely to be associated with diabetes?

Fournier's gangrene. Fournier's gangrene - This is a rare, life-threatening necrotizing fasciitis of the perineum and genital area, which can occur in people with diabetes but is not primarily or exclusively associated with the systemic vascular or neuropathic complications that lead to the other common types of gangrene in diabetic patients. - While diabetes is a risk factor for Fournier's gangrene due to immunosuppression, it's not a direct consequence of the typical diabetic microvascular or macrovascular disease processes that predominantly cause dry or wet gangrene [1]. Wet gangrene - This type of gangrene is highly associated with diabetes, often resulting from a combination of poor circulation, neuropathy, and infection in a moist environment [1]. - In diabetic patients, impaired immune function and high glucose levels create a favorable environment for bacterial growth, leading to rapid tissue destruction and liquefaction [1]. Dry gangrene - This is very common in diabetes due to the underlying atherosclerosis and peripheral artery disease, which lead to chronic ischemia without significant bacterial infection [1]. - Reduced blood flow, particularly to the extremities, causes tissue death and often results in a shriveled, dark, and mummified appearance [1]. Gas gangrene - Diabetics are at increased risk for gas gangrene due to their compromised immune systems and the development of wounds amenable to infection by Clostridium species [1]. - This rapid and aggressive infection is characterized by the production of gas in tissues and can arise from even minor trauma or surgical wounds in diabetic patients.

Q: Which type of healing occurs in an incisional wound with infection?

Secondary. ***Secondary*** - **Infection** prevents immediate closure, requiring the wound to heal by **granulation, contraction, and epithelialization**. - This process leads to a larger scar compared to primary closure. - In an infected wound, closure would trap bacteria and lead to abscess formation, so the wound must heal by **secondary intention**. *Primary* - Occurs when wound edges are **cleanly approximated** without significant tissue loss or infection, allowing for direct re-epithelialization. - This leads to the **fastest healing** and **minimal scarring**. - Requires clean wound with minimal bacterial contamination. *Delayed primary* - Involves leaving the wound open initially (3-5 days) to allow for **drainage or reduction of contamination** in a potentially contaminated wound. - The wound is then **surgically closed before granulation tissue forms** once the risk of infection is reduced. - Also called **tertiary intention** by some authors. *Tertiary* - Refers to a wound that is initially left open to heal by **secondary intention with granulation tissue formation**. - The wound is then **closed surgically after granulation tissue has formed**. - Distinct from delayed primary closure, which occurs before granulation develops.

Q: Which of the following is NOT a criterion for the viability of muscle?

Intact fascia. ***Intact fascia*** - The **fascia** is a connective tissue sheath surrounding muscles; its intactness is **not a direct indicator of muscle viability**. - While important for muscle integrity and function, a healthy, viable muscle can still exist even if its overlying fascia is disrupted or surgically opened. *Colour* - **Healthy muscle** generally has a **reddish-pink colour** due to its rich blood supply and myoglobin content. - **Pale, dusky, or black muscle** suggests **ischemia or necrosis**, indicating poor viability. *Contractility* - **Viable muscle** should be able to **contract** in response to direct electrical stimulation or mechanical irritation. - The **absence of contractility** indicates **muscle death or severe damage**, making it non-viable. *Bleeding when cut* - **Viable muscle** has an **intact blood supply** and will **bleed when incised**. - **Lack of bleeding** suggests **severe ischemia or necrosis**, indicating the muscle is non-viable.

Q: The image below shows a pressure sore. Which stage does this belong to?

Stage 4. ***Stage 4*** - The image clearly shows **extensive tissue loss**, including exposed bone and muscle, indicating a **deep tissue injury**. - The presence of large areas of **dead tissue (eschar)**, undermining, and tunneling are characteristic features of a stage 4 pressure sore. *Stage 1* - This stage involves **intact skin** with non-blanchable redness, indicating only superficial damage. - There is no **break in the skin** or tissue loss in Stage 1 pressure sores. *Stage 2* - Characterized by **partial-thickness skin loss**, presenting as an open blister or shallow ulcer. - **No visible deeper tissue** such as fat, muscle, or bone is exposed in this stage. *Stage 3* - Involves **full-thickness skin loss** with visible subcutaneous fat, but bone, tendon, or muscle are not exposed. - While there may be **undermining or tunneling**, the deep structures are not yet visible as seen in the image.

Q: What type of knot is depicted in the image?

Granny knot. ***Granny knot*** - The image shows a knot where the two half-knots are tied in the **same direction** (left over right, then left over right again, or vice versa), causing it to be unstable and slip. - This instability makes it less secure than a reef knot, as the two end pieces emerge parallel but on opposite sides of the loop. - The granny knot is an **insecure knot** that should be avoided in surgery as it can spontaneously untie. *Surgeon's knot* - A surgeon's knot involves an **extra throw** (double wrap) around the first loop to increase friction and make it more secure, which is not depicted here. - It is typically used to ensure that the first throw holds tension while the second throw is being tied. *Reef knot* - A reef knot (or square knot) is formed by tying two half-knots in **opposite directions** (left over right, then right over left), which creates a flat, stable, and secure knot. - In a reef knot, the two end pieces emerge parallel and on the same side of the loop, unlike the granny knot. *Half hitch* - A half hitch is a simple overhand knot around a standing part of the rope, used as a single throw or in combination with other knots. - It is not the same as the double-throw configuration shown in the image.

Q: Identify the surgical instrument based on the following characteristics: short blades, sharp cutting edges, and a central screw or rivet. Commonly used for cutting sutures.

Suture Scissors. ***Suture Scissors*** - Characterized by **short, sharp blades** and a central screw, making them ideal for precision cutting of sutures. - Their design allows for a **clean cut** through suture material without fraying, which is crucial in surgical settings. - Also known as **stitch scissors** or suture removal scissors, commonly used for cutting sutures during wound closure or suture removal. *Metzenbaum Scissors* - Known for their **long, slender shafts** and delicate blades, primarily used for **dissecting delicate tissues**. - Designed for blunt and sharp dissection of fine tissues rather than suture cutting. - Their longer, more delicate design makes them less ideal for the quick, precise cutting required for suture removal. *Mayo Scissors* - Possess **sturdy, heavy blades** that can be straight or curved, designed for cutting **tough tissues**, fascia, and heavy sutures. - Their robust construction is designed for cutting dense tissue rather than the fine, precise work of routine suture cutting. - Available in straight (for cutting sutures on skin) and curved (for cutting deep tissues) varieties. *Iris Scissors* - These are very **fine, delicate scissors** with extremely sharp, pointed tips, mainly used in **ophthalmic surgery** and other microsurgical procedures. - While they **can cut fine sutures** (6-0, 7-0) with precision, they are more specialized for delicate tissue dissection. - Their very fine tips make them less suitable as general-purpose suture scissors compared to dedicated stitch scissors.

Q: Which of the following statements is true about the suture material shown in the image?

Degraded by enzymatic degradation. ***Degraded by enzymatic degradation*** - Catgut sutures are **natural absorbable sutures** made primarily from purified collagen. - Their absorption in the body occurs through **enzymatic degradation** and phagocytosis, which is a key characteristic distinguishing them from synthetic absorbable sutures that undergo hydrolysis. *Made of cat submucosa* - While historically referred to as "catgut," these sutures are not actually made from cat intestines. - They are typically derived from the **submucosa of sheep or goat intestines**. *Not degraded* - Catgut sutures are explicitly classified as **absorbable surgical sutures**, as stated on the packaging. - Absorbable sutures by definition are designed to be broken down and **resorbed by the body** over time. *Made of rabbit submucosa* - Catgut sutures are not typically made from rabbit submucosa. - The primary sources for natural absorbable sutures like catgut are the **intestines of sheep or goats**.

Question 1

Which of the following sutures has maximum tensile strength and minimum tissue reaction?

Accepted Answer

Polypropylene

Answer

Poliglecaprone

Answer

Polydioxanone

Answer

Polyglactin

Question 2

Prolonged surgery time of vaginal hysterectomy may lead to damage to which of the following nerves?

Accepted Answer

Peroneal

Answer

Obturator

Answer

Sural

Answer

Pudendal

Question 3

For how many weeks do cortisol levels typically remain elevated following a hemorrhage?

Accepted Answer

2 weeks

Answer

1 week

Answer

3 weeks

Answer

4 weeks

Question 4

Which of the following types of gangrene is least likely to be associated with diabetes?

Accepted Answer

Fournier's gangrene

Answer

Dry gangrene

Answer

Wet gangrene

Answer

Gas gangrene

Question 5

Which type of healing occurs in an incisional wound with infection?

Accepted Answer

Secondary

Answer

Primary

Answer

Delayed primary

Answer

Tertiary

Question 6

Which of the following is NOT a criterion for the viability of muscle?

Accepted Answer

Intact fascia

Answer

Contractility

Answer

Colour

Answer

Bleeding when cut

Question 7

The image below shows a pressure sore. Which stage does this belong to?

Accepted Answer

Stage 4

Answer

Stage 1

Answer

Stage 2

Answer

Stage 3

Question 8

What type of knot is depicted in the image?

Accepted Answer

Granny knot

Answer

Half hitch

Answer

Surgeon’s knot

Answer

Reef knot

Question 9

Identify the surgical instrument based on the following characteristics: short blades, sharp cutting edges, and a central screw or rivet. Commonly used for cutting sutures.

Accepted Answer

Suture Scissors

Answer

Metzenbaum Scissors

Answer

Mayo Scissors

Answer

Iris Scissors

Question 10

Which of the following statements is true about the suture material shown in the image?

Accepted Answer

Degraded by enzymatic degradation

Answer

Made of cat submucosa

Answer

Not degraded

Answer

Made of rabbit submucosa

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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