General Surgery Principles Practice Questions

Q: Early surgery is indicated in which of the following conditions causing peritonitis?

Biliary peritonitis. **Explanation:** In the management of peritonitis, the decision for surgery depends on whether the underlying cause is a chemical insult, a primary infection, or a secondary bacterial perforation. **Why Biliary Peritonitis is the Correct Answer:** Biliary peritonitis is a form of **chemical peritonitis** caused by the leakage of bile into the peritoneal cavity (often due to gallbladder perforation or post-surgical leaks). Bile is highly irritant; it causes rapid fluid shifts, severe inflammation, and carries a high risk of secondary bacterial infection. **Early surgical intervention** is mandatory to source-control the leak, perform peritoneal lavage, and prevent the rapid progression to systemic inflammatory response syndrome (SIRS) and multi-organ failure. **Analysis of Incorrect Options:** * **Amoebiasis Peritonitis:** This is typically a complication of an amoebic liver abscess rupturing into the peritoneum. The primary treatment is **medical management** with intravenous metronidazole and percutaneous aspiration/drainage. Surgery is reserved only for patients who fail to respond to medical therapy or show signs of frank fecal peritonitis. * **Typhoid Peritonitis:** While typhoid can lead to ileal perforation requiring surgery, the initial management focuses on **resuscitation and stabilization** with antibiotics. Surgery is indicated once the patient is hemodynamically stable, but it is not considered as "immediate" or "early" in the same chemical-urgency sense as a bile leak. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Biliary Peritonitis:** Early cholecystectomy or repair of the biliary leak with thorough peritoneal toilet. * **Chemical vs. Bacterial:** Chemical peritonitis (Bile, Gastric Acid) requires faster intervention to prevent the transition to bacterial peritonitis. * **Amoebic Abscess:** "Anchovy sauce" pus is characteristic. Surgery is rarely the first-line treatment.

Q: Which of the following materials used for implants evokes the least inflammatory tissue response?

Polypropylene. **Explanation:** The degree of tissue reaction to an implant or suture material depends on its chemical composition and physical structure. **Polypropylene** is a synthetic, non-absorbable monofilament polymer. Because it is chemically inert and has a smooth, non-porous surface, it evokes the **least inflammatory tissue response** among the options provided. Its monofilament nature also prevents "wicking" of bacteria, making it ideal for use in contaminated fields and for vascular anastomoses. **Analysis of Incorrect Options:** * **Bovine Collagen:** Being a natural protein derived from animals, it is highly immunogenic. It triggers a significant inflammatory response as the body recognizes it as foreign protein and eventually degrades it via enzymatic digestion. * **Polyglactin (Vicryl):** This is a synthetic absorbable braided suture. While it is more inert than natural materials, it is designed to be broken down by hydrolysis. This process, along with its braided structure, induces a moderate inflammatory reaction compared to polypropylene. * **Cotton:** As a natural cellulose-based fiber, cotton evokes a robust inflammatory response. Its multifilament (twisted) structure provides a large surface area for cellular attachment and can harbor bacteria, leading to significant tissue reaction and potential granuloma formation. **High-Yield Clinical Pearls for NEET-PG:** * **Least Reactive:** Polypropylene and Stainless Steel. * **Most Reactive:** Natural materials like Silk and Catgut. * **Suture of Choice:** Polypropylene is the gold standard for **vascular surgery** and **hernia repair (mesh)** due to its high tensile strength and minimal reactivity. * **Absorption Mechanism:** Synthetic sutures (e.g., Polyglactin) are absorbed by **hydrolysis**, whereas natural sutures (e.g., Catgut) are absorbed by **proteolysis/enzymatic digestion**.

Q: Following trauma, which hormone is not released?

Thyroxine. **Explanation:** The metabolic response to trauma is characterized by a complex neuroendocrine activation aimed at maintaining hemodynamic stability and mobilizing energy substrates. This response is divided into the **Ebb phase** (initial shock) and the **Flow phase** (catabolism and hypermetabolism). **Why Thyroxine is the Correct Answer:** Unlike most hormones, **Thyroxine (T4) and Triiodothyronine (T3) levels typically decrease** or remain unchanged following major trauma. This phenomenon is known as "Sick Euthyroid Syndrome." The body downregulates the conversion of T4 to T3 to lower the basal metabolic rate and conserve energy during the acute stress phase. Therefore, it is not "released" in response to trauma. **Analysis of Incorrect Options:** * **Glucagon:** Released by the pancreas in response to catecholamines. It promotes glycogenolysis and gluconeogenesis, contributing to post-traumatic hyperglycemia. * **ADH (Vasopressin):** Released from the posterior pituitary due to hypovolemia and pain. It acts on the kidneys to conserve water and maintain blood pressure. * **GH (Growth Hormone):** Released from the anterior pituitary. While traditionally anabolic, in trauma, it acts synergistically with cortisol to promote lipolysis and insulin resistance. **NEET-PG High-Yield Pearls:** * **Hormones that Increase:** Cortisol (the primary stress hormone), Catecholamines (Adrenaline/Noradrenaline), Glucagon, ADH, GH, and Renin-Angiotensin-Aldosterone. * **Hormones that Decrease:** Insulin (relative deficiency/resistance), T3/T4, and Gonadotropins (Testosterone/Estrogen). * **The "Ebb" Phase:** Characterized by decreased CO, decreased O2 consumption, and decreased body temperature. * **The "Flow" Phase:** Characterized by increased CO, increased O2 consumption, and hypermetabolism.

Q: What is the most common primary source of brain metastases?

Lung. **Explanation:** Brain metastases are the most common intracranial tumors in adults, occurring much more frequently than primary brain malignancies. **Why Lung is Correct:** **Lung cancer** is the most common primary source, accounting for approximately **40–50%** of all brain metastases. This is due to the high incidence of lung cancer and its unique hematogenous spread pattern; cancer cells entering the pulmonary circulation gain direct access to the systemic arterial circulation, allowing them to bypass the "filter" of the lungs and seed directly into the brain. Small cell lung cancer (SCLC) has a particularly high propensity for early CNS involvement. **Analysis of Incorrect Options:** * **Breast Cancer (Option C):** This is the **second most common** source (approx. 15–25%). It is more common in younger women and specifically associated with HER2-positive and Triple-Negative subtypes. * **Melanoma (Option D):** While melanoma has the **highest propensity** (percentage risk per individual case) to spread to the brain, it is less common overall than lung or breast cancer due to its lower general incidence. * **Liver (Option B):** Primary Hepatocellular Carcinoma (HCC) rarely metastasizes to the brain; it more commonly spreads to the lungs or bone. **NEET-PG High-Yield Pearls:** 1. **Most common source overall:** Lung > Breast > Melanoma > Renal > GI. 2. **Highest propensity to bleed:** Melanoma, Choriocarcinoma, Renal Cell Carcinoma (RCC), and Thyroid cancer. 3. **Location:** Most brain metastases (80%) occur in the cerebral hemispheres, typically at the **grey-white matter junction** where narrowing vessel diameters trap tumor emboli. 4. **Multiplicity:** Lung cancer and melanoma usually present with multiple lesions, whereas Breast, RCC, and Colon cancer often present as a solitary metastasis.

Q: What is the most common mediastinal tumor?

Neurogenic tumor. **Explanation:** The mediastinum is divided into anterior, middle, and posterior compartments. When considering the **entire mediastinum**, **neurogenic tumors** are the most common primary neoplasms (accounting for approximately 20-25% of all cases). These tumors are most frequently located in the **posterior mediastinum**, where they arise from peripheral nerves, sympathetic chains, or paraganglia. **Analysis of Options:** * **A. Neurogenic tumor (Correct):** These are the most common mediastinal masses overall. In adults, they are usually benign (e.g., Schwannoma, Neurofibroma), whereas in children, they are more likely to be malignant (e.g., Neuroblastoma). * **B. Pericardial cyst:** These are the most common cysts of the **middle mediastinum**, but they are far less common than neurogenic tumors overall. * **C. Hernia:** While Morgagni (anterior) and Bochdalek (posterior) hernias can present as mediastinal masses, they are developmental diaphragmatic defects rather than primary tumors. * **D. Teratoma:** These are the most common germ cell tumors of the mediastinum, typically located in the **anterior mediastinum**. While common in that specific compartment, they do not surpass neurogenic tumors in total frequency. **High-Yield Clinical Pearls for NEET-PG:** * **Anterior Mediastinum (The 4 Ts):** Thymoma (most common anterior mass), Teratoma, Thyroid (Retrosternal Goiter), and "Terrible" Lymphoma. * **Middle Mediastinum:** Lymphadenopathy is the most common cause of a mass here; pericardial and bronchogenic cysts are also found. * **Posterior Mediastinum:** Neurogenic tumors are the hallmark of this compartment. * **Rule of Thumb:** If the question asks for the most common mediastinal tumor in **adults**, it is Neurogenic; if it asks for the most common **anterior** mediastinal tumor, it is Thymoma.

Question 1

Early surgery is indicated in which of the following conditions causing peritonitis?

Accepted Answer

Biliary peritonitis

Answer

Amoebiasis peritonitis

Answer

Typhoid peritonitis

Answer

All of the above

Question 2

Which of the following materials used for implants evokes the least inflammatory tissue response?

Accepted Answer

Polypropylene

Answer

Bovine collagen

Answer

Polygiactin

Answer

Cotton

Question 3

Following trauma, which hormone is not released?

Accepted Answer

Thyroxine

Answer

Glucagon

Answer

ADH

Answer

GH

Question 4

In a splenectomized patient, there is an increased risk of infection by which of the following organisms?

Accepted Answer

Staphylococcus aureus

Answer

Pneumococci

Answer

Klebsiella

Answer

Haemophilus influenzae

Question 5

What is the most common primary source of brain metastases?

Accepted Answer

Lung

Answer

Liver

Answer

Breast

Answer

Melanoma

Question 6

A 43-year-old man presents with severe perineal pain. Examination reveals exquisite tenderness to the right of the anal verge due to a perianal abscess. Rectal examination is refused. What is the next step in management?

Accepted Answer

Drainage of the abscess in the office under local anesthesia.

Answer

Excision of the vertical fold of Morgagni.

Answer

Drainage under general anesthesia and immediate colonoscopy.

Answer

CT scan of the abdomen.

Question 7

What is the most common mediastinal tumor?

Accepted Answer

Neurogenic tumor

Answer

Pericardial cyst

Answer

Hernia

Answer

Teratoma

Question 8

Which of the following procedures is suitable for day care surgery?

Accepted Answer

Lateral sphincterotomy

Answer

Rhinoplasty

Answer

Orchidectomy

Answer

Total thyroidectomy

Question 9

Which of the following is NOT included in the etiopathogenesis of diabetic foot?

Accepted Answer

Myelopathy

Answer

Osteoarthropathy

Answer

Microangiopathy

Answer

Infection

Question 10

The infection from a lower third molar pericoronal area spreads mostly to which space?

Accepted Answer

Pterygomandibular space

Answer

Submandibular space

Answer

Submental space

Answer

Buccal space

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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