General Surgery Principles — MCQs

General Surgery Principles Indian Medical PG Practice Questions and MCQs

Question 901: What is the medical procedure that involves the removal of dead, damaged, or infected tissue from a wound?

A. Debridement (Correct Answer)
B. Surgical removal of tissue
C. Cleaning of the wound
D. Application of antiseptic

Explanation: ***Debridement*** - **Debridement** is the precise medical term referring to the removal of **dead**, damaged, or infected tissue to promote wound healing. - This procedure is crucial for preventing infection, reducing inflammation, and allowing healthy tissue to regenerate. *Surgical removal of tissue* - While debridement can be performed surgically, "surgical removal of tissue" is a broader, less specific term and does not exclusively refer to the removal of *dead* or *damaged* tissue from a wound. - This term could apply to the removal of healthy tissue (e.g., in a biopsy) or diseased tissue that is not necessarily dead or damaged (e.g., tumor excision). *Cleaning of the wound* - **Cleaning of the wound**, often called irrigation, involves removing foreign particles, debris, and surface contaminants but does not specifically refer to the removal of **necrotic** or **non-viable tissue**. - Wound cleaning is typically a preparatory step for debridement or dressing changes, not the process of tissue removal itself. *Application of antiseptic* - The **application of antiseptic** involves using chemical agents to inhibit the growth of microorganisms on living tissue to prevent infection, not the physical removal of tissue. - Antiseptics reduce the bioburden but do not remove necrotic tissue, which often harbors bacteria.

Question 902: Which of the following is typical of rectus sheath hematoma?

A. Bluish discoloration
B. Firm painful mass (Correct Answer)
C. Ecchymosis
D. Severe tenderness

Explanation: ***Firm painful mass*** - A rectus sheath hematoma typically presents as a **firm, painful, and often well-circumscribed mass** within the abdominal wall. - The pain is usually localized to the site of the hematoma, often in the **lower quadrants of the abdomen**. *Bluish discoloration* - While some hematomas can cause skin discoloration, **bluish discoloration** (like a bruise) is possible but not the most defining or typical feature of a rectus sheath hematoma itself. - More often, the discoloration may be delayed or less prominent, especially with **deeper hematomas**. *Ecchymosis* - **Ecchymosis** (bruising) can occur with a rectus sheath hematoma if the bleeding is superficial or extensive enough to reach the skin. - However, it's not universally present and the defining characteristic is the presence of a **palpable mass**. *Severe tenderness* - **Severe tenderness** is certainly present, but it's part of the broader symptomology that includes a **palpable, firm mass**. - Without the presence of a mass, severe tenderness alone is less specific to rectus sheath hematoma compared to the combination of a **firm, painful mass**.

Question 903: Most important factor in causation of ingrown toenail is?

A. Fungal infection
B. Ill fitting shoes (Correct Answer)
C. Genetic predisposition
D. Nutritional deficiency

Explanation: ***Ill fitting shoes*** - **Tight or narrow shoes** compress the toes, pushing the soft tissue against the nail edge, leading to the nail growing into the skin. - This consistent pressure and irritation are a primary mechanical cause of **onychocryptosis**. *Fungal infection* - While fungal infections (onychomycosis) can cause nail thickening and deformity, they are not the primary cause of an ingrown toenail itself. - Fungal infections primarily affect the **nail plate** and **nail bed**, changing nail texture and color. *Genetic predisposition* - While certain **foot shapes** or **nail plate curvatures** may make an individual more prone to ingrown toenails, genetic factors are not the most direct or modifiable cause. - Genetic predisposition may increase susceptibility, but external factors like footwear are often the precipitating cause. *Nutritional deficiency* - Nutritional deficiencies can affect nail health, leading to brittleness, slow growth, or abnormal nail plates. - However, they do not directly cause the nail to **penetrate the surrounding skin**, which is the hallmark of an ingrown toenail.

Question 904: Which of the following statements regarding hydrocele management and characteristics is correct?

A. Lord's plication is contraindicated in thick-walled hydroceles
B. Communicating hydrocele is more common in adults than children
C. Jaboulay's procedure involves eversion of the tunica vaginalis (Correct Answer)
D. Aspiration is the preferred definitive treatment for primary hydrocele

Explanation: **Jaboulay's procedure involves eversion of the tunica vaginalis** - **Jaboulay's procedure** is a surgical technique for hydrocele repair where the **parietal layer of the tunica vaginalis is everted** and sutured behind the epididymis and spermatic cord. - This eversion exposes the serosal surface, which absorbs the hydrocele fluid, preventing its reaccumulation. *Communicating hydrocele is more common in adults than children* - **Communicating hydroceles** are more common in children due to the persistence of a patent **processus vaginalis**. - In adults, most hydroceles are **non-communicating** and arise from an imbalance in fluid secretion and absorption within the tunica vaginalis. *Lord's plication is contraindicated in thick-walled hydroceles* - **Lord's plication** is a technique where the redundant tunica vaginalis is folded and sutured, which is **effective for thin-walled hydroceles**. - It is often avoided in cases of **thick-walled or calcified hydroceles** (often due to chronic inflammation) because the tissue is too rigid to plicate effectively, and recurrence rates may be higher. *Aspiration is the preferred definitive treatment for primary hydrocele* - **Aspiration** provides only temporary relief as the fluid almost always reaccumulates, thus it is not considered a **definitive treatment**. - Definitive treatment for primary hydroceles typically involves surgical intervention, such as **eversion** (Jaboulay) or **plication** (Lord's) of the tunica vaginalis.

Question 905: What is another name for Pantaloon hernia?

A. Retrosternal hernia
B. Saddle bag hernia (Correct Answer)
C. Dual hernia
D. Bochdalek's hernia

Explanation: ***Saddle bag hernia*** - A **Pantaloon hernia** is characterized by having both a **direct** and an **indirect inguinal hernia** coexisting side-by-side, straddling the **inferior epigastric artery**. - The term **"saddle bag hernia"** is the most commonly used alternate name, describing how the hernia straddles the inferior epigastric artery like **saddlebags** over a horse. - This is the established synonym in surgical literature and examination contexts. *Dual hernia* - While descriptive of the "dual" or two-sided nature (direct + indirect components), this is **not the recognized alternate name** for Pantaloon hernia. - It is an anatomical description rather than an established medical terminology. *Retrosternal hernia* - A **retrosternal hernia** (or **Morgagni hernia**) is a type of **diaphragmatic hernia** where abdominal contents protrude into the chest through a defect behind the sternum. - This is unrelated to inguinal hernias and describes a completely different anatomical location and type of defect. *Bochdalek's hernia* - **Bochdalek's hernia** is another type of **diaphragmatic hernia**, typically occurring posterolaterally through a defect in the diaphragm, often presenting in infants. - It involves the displacement of abdominal organs into the thoracic cavity and is distinct from inguinal hernias.

Question 906: Prolonged surgery time of vaginal hysterectomy may lead to damage to which of the following nerves?

A. Obturator
B. Sural
C. Pudendal
D. Peroneal (Correct Answer)

Explanation: ***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.

Question 907: Which of the following sutures has maximum tensile strength and minimum tissue reaction?

A. Poliglecaprone
B. Polypropylene (Correct Answer)
C. Polydioxanone
D. Polyglactin

Explanation: ***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.

Question 908: Which of the following statements about umbilical hernias is true?

A. Most of the umbilical hernias disappear spontaneously (Correct Answer)
B. Males are affected more than females
C. Most common content is small intestine
D. Surgical repair should be done at 1 year of age

Explanation: ***Most of the umbilical hernias disappear spontaneously*** - Umbilical hernias in infants and young children frequently close without intervention, often by the age of **2 to 3 years**, due to the natural strengthening of the abdominal wall. - This spontaneous closure is observed in a high percentage of cases, making watchful waiting a common and appropriate management strategy. *Most common content is small intestine* - The most common contents of an umbilical hernia are generally **omentum** or **a loop of large intestine**, not typically the small intestine. - The small intestine is more frequently seen in larger or complicated hernias, but not as the predominant content in most cases. *Males are affected more than females* - Umbilical hernias are actually observed **more frequently in females** than in males, although the difference can be slight in some populations. - They are also more common in **African Americans** and premature infants. *Surgical repair should be done at 1 year of age* - Surgical repair is generally recommended for umbilical hernias that **persist beyond 4 to 5 years of age**, are rapidly enlarging, or become symptomatic (e.g., pain, incarceration). - Repair at **1 year of age** is typically too early as most hernias at this age would still be expected to close spontaneously.

Question 909: Which type of healing occurs in an incisional wound with infection?

A. Primary
B. Delayed primary
C. Secondary (Correct Answer)
D. Tertiary

Explanation: ***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.

Question 910: Normal time for wound healing to transition from proliferative to maturation phase after injury is?

A. 2 weeks
B. 3 weeks (Correct Answer)
C. 4 weeks
D. 5 weeks

Explanation: ***4 weeks*** - The normal time for scar formation is generally around **4 weeks**, allowing for significant collagen deposition and remodeling [1]. - This timeframe signifies the transition from initial wound healing to the maturation phase where the scar solidifies. *2 weeks* - At 2 weeks, the healing is in the **inflammatory** and early proliferative phase, not fully developed into a scar. - Scar formation generally requires a longer duration for sufficient **collagen synthesis** and tissue remodeling. *3 weeks* - By 3 weeks, the wound is progressing, but it still lacks the **structural integrity** of a mature scar. - Scar formation typically reaches its recognizable stage by **4 weeks**, with formal remodeling continuing thereafter. *5 weeks* - While healing continues past 4 weeks, **5 weeks** is longer than the typical duration for initial scar formation, possibly suggesting delayed healing. - By this point, the scar should be present, but significant remodeling will still occur beyond this period. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 117-119.

Practice by Chapter

Wound Healing and Care

Practice Questions

Surgical Infections

Practice Questions

Fluid and Electrolyte Management

Practice Questions

Nutrition in Surgical Patients

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Hemostasis and Blood Transfusion

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Surgical Instruments and Equipment

Practice Questions

Sutures and Stapling Devices

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Minimal Access Surgery Principles

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Surgical Complications

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Anesthesia Principles for Surgeons

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Surgical Oncology Principles

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Evidence-Based Surgery

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