General Surgery Principles Practice Questions

Q: Which of the following statements about keloids is MOST true?

Keloids may extend beyond the original wound.. ***Keloids may extend beyond the original wound.*** - Keloids are characterized by their **overgrowth** beyond the boundaries of the original injury. - This distinguishes them from **hypertrophic scars**, which remain confined to the wound edges. *Extended excision is often not the treatment of choice.* - **Excision alone** is usually insufficient for keloids and can even be counterproductive, as the recurring wound often leads to a larger keloid. - While excision can be part of a treatment plan, it is typically combined with supplementary therapies like **steroid injections** or **radiation therapy** to prevent recurrence. *It contains growth factors.* - While keloids involve abnormal fibroblast activity and deposition of **extracellular matrix**, the statement that it "contains growth factors" is too vague and not a defining characteristic that differentiates it from a range of other tissues or conditions. - Many tissues and healing processes involve growth factors, so this statement alone does not provide a specific or most true characteristic of keloids. *None of the options.* - This option is incorrect because the statement that **keloids may extend beyond the original wound** is a hallmark characteristic of keloids and is definitively true.

Q: Identify the type of retractor shown in the image.

Weitlaner retractor. ***Weitlaner retractor*** - The image displays a **self-retaining retractor** with two sets of curved blades with sharp prongs, which is characteristic of a Weitlaner retractor. - **Weitlaner retractors** are commonly used in various surgical procedures, particularly in orthopedic, neurosurgical, and superficial soft tissue surgeries, to hold back wound edges for better visualization. - They feature a self-retaining mechanism with a ratchet lock and typically have 2-3 prongs on each blade. *Czerny retractor* - A **Czerny retractor** is a handheld, double-ended retractor with L-shaped blades of different sizes, not a self-retaining type as shown. - It is typically used for retracting shallow or superficial tissues in abdominal surgery. *Richardson retractor* - A **Richardson retractor** is a handheld, single-ended retractor with a curved lip, often used for deep tissue retraction in abdominal surgeries. - It does not have the self-retaining mechanism or multiple-pronged blades seen in the image. *Lower lid retractor* - A **lower lid retractor** is a small, specialized retractor designed for ophthalmic surgery to retract the eyelid, and its shape is distinct from the instrument shown. - It is much smaller and has a smooth, curved blade to fit the contour of the eyelid.

Q: What is the typical absorption duration of Polydioxanone sutures?

6 months. ***Correct: 6 months*** - **Polydioxanone (PDS) sutures** are known for their **prolonged absorption time**, typically ranging from 180 to 210 days, or approximately 6 months. - This characteristic makes PDS sutures suitable for tissues requiring **extended support** during the healing process. - PDS retains approximately **50% tensile strength at 4 weeks** and **25% at 6 weeks**, with complete absorption occurring over 6-7 months. *Incorrect: 2 weeks* - An absorption duration of 2 weeks is characteristic of **rapidly absorbing sutures**, such as **chromic gut** or **fast-absorbing synthetic sutures**, which are used for tissues that heal quickly or require minimal support. - PDS sutures offer much longer tensile strength retention and absorption than this brief period. *Incorrect: 4 weeks* - A 4-week absorption time is considerably shorter than that of PDS sutures. This duration might be seen with some **intermediate-absorbing sutures**, but not with the long-lasting PDS. - Sutures absorbed in this timeframe would not provide sufficient support for tissues where PDS is typically indicated. *Incorrect: 6 weeks* - While longer than 2 or 4 weeks, 6 weeks (approximately 42 days) is still much shorter than the typical absorption profile of PDS sutures. - Sutures like **Vicryl Rapide** might fall into this absorption range, but PDS is designed for applications needing several months of support.

Q: Which of the following is NOT a principle of negative pressure wound therapy?

Clearance of infection. ***Clearance of infection*** - While negative pressure wound therapy (NPWT) can help manage heavily colonized wounds by removing exudate and reducing bacterial burden, it is **not a primary treatment for active infection**. - **Systemic antibiotics** or local antiseptics are required to truly clear an infection, as NPWT alone cannot eliminate deep-seated pathogens. *Stabilization of wound environment* - NPWT helps to **stabilize the wound bed** by holding it in place, protecting it from external contamination and mechanical stress. - This creates an optimal environment for **wound healing** by preventing disruption of newly formed granulation tissue. *Macrodeformation of the wound* - The negative pressure applied to the wound surface causes the wound edges to be drawn together, leading to **macrodeformation**. - This effect reduces wound size and promotes **epithelialization** and **wound contraction**. *Decreased edema* - NPWT actively removes **excess interstitial fluid** and exudate from the wound bed, leading to a significant reduction in edema. - This reduction in swelling improves **perfusion** to the wound tissues and promotes better healing.

Q: Which type of surgical suture is known to cause the most tissue reaction?

Silk. ***Silk*** - Silk is a **natural, braided, non-absorbable suture** that is known to elicit a significant **inflammatory reaction** due to its natural protein composition and braided structure. - While it was historically used for its good handling properties, its high tissue reactivity makes it less ideal for situations where minimal scarring or inflammation is desired. - **Silk causes the most tissue reaction** among commonly used sutures. *Plain Catgut* - Plain catgut is a **natural, absorbable suture** derived from purified collagen of animal intestines, causing a moderate to high tissue reaction. - However, its absorption by enzymatic hydrolysis is relatively rapid, limiting the duration of the inflammatory response compared to non-absorbable natural materials like silk. *Polydiaxonone* - Polydiaxonone (PDS) is a **synthetic, monofilament, absorbable suture** known for causing a relatively **low tissue reaction**. - Its slow absorption profile and monofilament structure contribute to its minimal inflammatory response, making it suitable for tissues requiring prolonged support. *Chromic Catgut* - Chromic catgut is a treated form of plain catgut that has been coated with chromium salts, which prolong its absorption time and reduce its tissue reactivity compared to plain catgut. - Although it is still a natural, absorbable suture, its tissue reaction is **less than both plain catgut and silk**, but greater than synthetic monofilament sutures like PDS.

Q: An Incisional wound heals by

Primary Healing. ***Primary Healing*** - An **incisional wound** is typically a clean, sharply incised wound with **minimal tissue loss** and edges that can be approximated. - **Primary healing** (or first intention) occurs when the wound edges are surgically closed, leading to rapid healing with minimal scarring. *Secondary Healing* - This type of healing occurs in wounds with **significant tissue loss** or infection, where the edges cannot be approximated. - The wound must heal by **granulation tissue formation** and **wound contraction**, resulting in a larger scar. *Epithelialization* - **Epithelialization** is a vital process in all types of wound healing, where epithelial cells migrate to cover the wound surface. - However, it describes a *process* rather than a *mode* of overall wound healing for a closed incisional wound. *Delayed primary Healing* - **Delayed primary healing** (or tertiary intention) involves leaving a wound open for a period (e.g., to control infection or edema) before closing it surgically. - This approach is not typical for a clean incisional wound but is used in cases where primary closure is initially unsafe.

Q: Vacuum assisted closure is contraindicated in which of the following conditions -

Large amount of necrotic tissue with eschar. ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.

Q: Which of the following is the correct management of abdominal compartment syndrome?

Urgent decompressive laparotomy. ***Urgent decompressive laparotomy*** - The definitive treatment for abdominal compartment syndrome (ACS) is **urgent surgical decompression** via **decompressive laparotomy**. - This involves opening the abdominal fascia to immediately **reduce intra-abdominal pressure (IAP)**, typically indicated when IAP >20 mmHg with new organ dysfunction. - Decompression is crucial to prevent irreversible organ damage, restore perfusion to compressed organs, and improve ventilation. - The abdomen is often left open temporarily with negative pressure wound therapy until the patient stabilizes. *Antihypertensives* - Antihypertensives may manage systemic hypertension but do not address the **elevated intra-abdominal pressure** that is the primary pathology in ACS. - This approach is insufficient and could worsen **organ perfusion** by reducing the perfusion pressure gradient (MAP - IAP) to already compressed abdominal organs. - ACS requires mechanical decompression, not pharmacological blood pressure management. *Urgent Fasciotomy* - Fasciotomy is the correct treatment for **extremity compartment syndrome** (e.g., leg, forearm), where it relieves pressure within muscle compartments. - It is anatomically inappropriate for **abdominal compartment syndrome**, which requires opening the abdominal cavity, not limb fascial compartments. - This represents a fundamental misunderstanding of the anatomical site requiring decompression. *Wait and monitor for 24 hours* - ACS is a **surgical emergency** that can rapidly progress to multiorgan failure, acute kidney injury, respiratory failure, and cardiovascular collapse. - Delaying intervention by 24 hours would likely result in **irreversible organ damage** and significantly increased mortality. - Once diagnosed (IAP >20 mmHg with organ dysfunction), urgent decompression is mandatory.

Q: What is the primary cause of a decubitus ulcer?

Prolonged pressure on the skin. ***Prolonged pressure on the skin*** - **Sustained pressure** on a bony prominence restricts blood flow, leading to **ischemia** and tissue death [1]. - This **impeded circulation** forms the direct cause of cell damage and ulcer formation [1]. *Due to trauma or injury* - While trauma can damage skin, a **decubitus ulcer** specifically results from **sustained pressure**, not typically from a single traumatic event. - Trauma usually leads to acute wounds, whereas pressure ulcers develop over time due to chronic tissue compromise. *Due to friction and shear forces* - **Friction** (skin rubbing against a surface) and **shear** (skin gliding over bone) contribute to decubitus ulcer development by damaging superficial vessels and tissues. - However, they are secondary factors that exacerbate the effects of **primary prolonged pressure**, rather than the initiating cause. *Due to moisture and immobility* - **Moisture** (e.g., from incontinence) macerates the skin, making it more susceptible to breakdown, and **immobility** prevents pressure relief. - These are significant **risk factors** that create an environment conducive to pressure ulcer formation, but the direct cause remains **sustained pressure** leading to ischemia.

Q: Which of the following statements is true about Marjolin's ulcer?

All of the options. ***All of the options*** - Marjolin's ulcer is a **malignant transformation** that occurs in chronic wounds and scars, which tend to be **long-standing**. - It most commonly leads to the development of **squamous cell carcinoma (SCC)**, and these lesions are generally **slow-growing**. *Squamous cell carcinoma develops* - This statement is true; the most common histological type of malignancy arising in a Marjolin's ulcer is **squamous cell carcinoma (SCC)**. - Less frequently, **basal cell carcinoma** or other sarcomas can also arise, but **SCC** is the predominant form. - The SCC arising in Marjolin's ulcer tends to be **more aggressive** than conventional SCC, with higher rates of **local invasion** and **metastasis**. *Slow growing lesion* - This statement is true; Marjolin's ulcer lesions typically exhibit a **slow growth rate** over an extended period. - This characteristic often contributes to delayed diagnosis, as patients may initially dismiss the changes as non-malignant wound complications. - The latency period can range from **years to decades** after the initial injury. *Develops in long standing scar* - This statement is true; Marjolin's ulcer is defined by its development in areas of **chronic inflammation**, such as **burn scars**, **pressure sores**, **venous stasis ulcers**, and other non-healing wounds. - The latency period for malignant transformation in such scars can range from years to decades, indicating a **long-standing** nature. - **Burn scars** are the most common site, accounting for the majority of cases.

Question 1

Which of the following statements about keloids is MOST true?

Accepted Answer

Keloids may extend beyond the original wound.

Answer

Extended excision is often not the treatment of choice.

Answer

It contains growth factors.

Answer

None of the options.

Question 2

Identify the type of retractor shown in the image.

Accepted Answer

Weitlaner retractor

Answer

Czerny retractor

Answer

Richardson retractor

Answer

Lower lid retractor

Question 3

What is the typical absorption duration of Polydioxanone sutures?

Accepted Answer

6 months

Answer

4 weeks

Answer

6 weeks

Answer

2 weeks

Question 4

Which of the following is NOT a principle of negative pressure wound therapy?

Accepted Answer

Clearance of infection

Answer

Macrodeformation of the wound

Answer

Decreased edema

Answer

Stabilization of wound environment

Question 5

Which type of surgical suture is known to cause the most tissue reaction?

Accepted Answer

Silk

Answer

Plain Catgut

Answer

Polydiaxonone

Answer

Chromic catgut

Question 6

An Incisional wound heals by

Accepted Answer

Primary Healing

Answer

Secondary Healing

Answer

Epithelialization

Answer

Delayed primary Healing

Question 7

Vacuum assisted closure is contraindicated in which of the following conditions -

Accepted Answer

Large amount of necrotic tissue with eschar

Answer

Chronic osteomyelitis

Answer

Abdominal wound

Answer

Surgical wound dehiscence

Question 8

Which of the following is the correct management of abdominal compartment syndrome?

Accepted Answer

Urgent decompressive laparotomy

Answer

Antihypertensives

Answer

Urgent Fasciotomy

Answer

Wait and monitor for 24 hours

Question 9

What is the primary cause of a decubitus ulcer?

Accepted Answer

Prolonged pressure on the skin

Answer

Due to friction and shear forces

Answer

Due to trauma or injury

Answer

Due to moisture and immobility

Question 10

Which of the following statements is true about Marjolin's ulcer?

Accepted Answer

All of the options

Answer

Squamous cell carcinoma develops

Answer

Slow growing lesion

Answer

Develops in long standing scar

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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