General Surgery Principles — MCQs

General Surgery Principles Indian Medical PG Practice Questions and MCQs

Question 921: Identify the type of retractor shown in the image.

A. Weitlaner retractor (Correct Answer)
B. Czerny retractor
C. Richardson retractor
D. Lower lid retractor

Explanation: ***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.

Question 922: Which of the following layers are cut during fasciotomy ?

A. Skin
B. Skin+subcutaneous tissue+Superficial fascia
C. Skin+subcutaneous tissue+Superficial fascia+deep fascia (Correct Answer)
D. Skin+subcutaneous tissue

Explanation: ***Skin+subcutaneous tissue+Superficial fascia+deep fascia*** - A **fasciotomy** is a surgical procedure to relieve **compartment syndrome** by releasing the **deep fascia** that constricts muscle compartments. - To access and incise the deep fascia, all overlying layers must be cut: **skin**, **subcutaneous tissue** (also called superficial fascia or hypodermis), and finally the **deep fascia** itself. - Note: "Superficial fascia" and "subcutaneous tissue" refer to the same anatomical layer, but both terms are listed here to reflect common clinical terminology. *Skin* - Cutting only the skin does not provide access to the deep fascia and cannot relieve compartment syndrome. - The skin is merely the outermost protective layer. *Skin+subcutaneous tissue* - While both these layers must be incised, stopping here leaves the **deep fascia** intact. - The deep fascia is the primary constricting structure in compartment syndrome and must be released. *Skin+subcutaneous tissue+Superficial fascia* - This option is anatomically redundant since superficial fascia and subcutaneous tissue are the same layer. - More importantly, this still does not include division of the **deep fascia**, which is essential for decompression in a true fasciotomy.

Question 923: What is the typical absorption duration of Polydioxanone sutures?

A. 4 weeks
B. 6 weeks
C. 2 weeks
D. 6 months (Correct Answer)

Explanation: ***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.

Question 924: An Incisional wound heals by

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

Explanation: ***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.

Question 925: Which of the following is NOT a principle of negative pressure wound therapy?

A. Macrodeformation of the wound
B. Decreased edema
C. Stabilization of wound environment
D. Clearance of infection (Correct Answer)

Explanation: ***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.

Question 926: Which type of surgical suture is known to cause the most tissue reaction?

A. Plain Catgut
B. Polydiaxonone
C. Silk (Correct Answer)
D. Chromic catgut

Explanation: ***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.

Question 927: During abdominal surgery under local anesthesia, the patient suddenly felt pain due to

A. Liver
B. Parietal peritoneum (Correct Answer)
C. Intestines
D. Visceral peritoneum

Explanation: ***Parietal peritoneum*** - The **parietal peritoneum** is richly innervated by somatic nerves (**spinal nerves**), making it highly sensitive to pain, pressure, and temperature. - When stimulated during surgery, even under local anesthesia which might not completely block deeper somatic nerves or if the local block is inadequate, it can cause the patient to suddenly feel **sharp, localized pain**. *Liver* - The liver itself has very few pain receptors in its parenchyma; pain from the liver typically arises from stretching of its fibrous capsule (**Glisson's capsule**). - This pain is usually dull and poorly localized, not the sudden, sharp pain typically experienced during surgical manipulation. *Intestines* - The intestines are primarily innervated by the **autonomic nervous system** and are sensitive to distension and ischemia, causing visceral pain, which is typically dull, crampy, and poorly localized. - They are generally not sensitive to cutting or burning, which are common surgical manipulations. *Visceral peritoneum* - The **visceral peritoneum** covers abdominal organs and is innervated by the autonomic nervous system, similar to the organs it covers. - Like the intestines, it is sensitive to stretch and ischemia, producing diffuse, poorly localized visceral pain rather than sharp, localized pain from surgical incision or manipulation.

Question 928: Which one of the following is used as a preservative for packing catgut suture?

A. Colloidal iodine
B. Glutaraldehyde
C. Isopropyl alcohol (Correct Answer)
D. Hydrogen peroxide

Explanation: ***Isopropyl alcohol*** - **Isopropyl alcohol** is commonly used as a preservative for **catgut sutures** due to its antiseptic and denaturing properties that prevent microbial growth and maintain the integrity of the biologic material. - It helps to keep the suture sterile and prevents degradation by enzymes or bacteria during storage. *Colloidal iodine* - **Colloidal iodine** is an antiseptic, but it is not typically used as a preservative for **catgut sutures**; it is more often used for skin preparation or wound disinfection. - Its reactivity and potential to stain or alter **suture material** make it less suitable for long-term preservation within the packaging. *Glutaraldehyde* - **Glutaraldehyde** is a potent disinfectant and sterilant, but it is generally too harsh for preserving **catgut sutures**; it can cause significant cross-linking and denaturation of proteins. - It is more commonly used for sterilizing heat-sensitive medical instruments like **endoscopes**, rather than for preserving **suture materials**. *Hydrogen peroxide* - **Hydrogen peroxide** is an oxidizing agent used as an antiseptic to clean wounds or as a sterilant, but it is not suitable for preserving **catgut sutures**. - Its oxidative action could degrade the **collagenous material** of the suture, compromising its strength and absorption properties.

Question 929: Which of the following nerves is commonly damaged during McBurney's incision?

A. Subcostal nerve
B. Iliohypogastric nerve (Correct Answer)
C. 11th thoracic nerve
D. 10th thoracic nerve

Explanation: ***Iliohypogastric nerve*** - The **iliohypogastric nerve** is most commonly injured during **McBurney's incision** due to its superficial position and transverse course at the level of the incision. - Damage can lead to **numbness** or altered sensation in the suprapubic region, and sometimes **weakness of the lower abdominal wall**. *Subcostal nerve* - The **subcostal nerve** (T12) runs inferior to the 12th rib and is generally superior to the typical site of a McBurney's incision. - Injury to this nerve is less common during this procedure compared to the iliohypogastric and ilioinguinal nerves. *10th thoracic nerve* - The **10th thoracic nerve** (T10) provides sensation around the umbilicus. - While it contributes to innervation of the abdominal wall, its location is typically well above the area of a standard McBurney's incision, making injury unlikely. *11th thoracic nerve* - The **11th thoracic nerve** (T11) innervates the abdominal wall and is located superior to the typical incision site for appendectomy. - Injury to T11 during a McBurney's incision is uncommon as the nerve's course lies cephalad to the surgical field.

Question 930: What type of wound is characterized by the scraping away of the skin?

A. Superficial wound
B. Tear in the skin
C. Abrasion (Correct Answer)
D. Deep tissue injury

Explanation: ***Abrasion*** - An **abrasion** is a wound caused by the **scraping or rubbing away of the superficial layers of the skin** (epidermis and sometimes superficial dermis). - It typically results from a fall or friction against a rough surface, common in children's scraped knees or elbows. *Superficial wound* - This is a **general term** and does not specifically describe the mechanism of injury as scraping. - A superficial wound could be a **minor cut or scratch** that doesn't involve scraping. *Tear in the skin* - A **tear in the skin** refers to a **laceration**, which is a wound caused by tearing of soft body tissue, often resulting in irregular edges. - This is distinct from the scraping action characteristic of an abrasion, where tissue is rubbed away rather than torn. *Deep tissue injury* - A **deep tissue injury (DTI)** is a **pressure-related injury** characterized by intact skin with **discoloration** (e.g., maroon or purple) or a blood-filled blister due to damage of underlying soft tissue. - It is not caused by external scraping and involves deeper tissue layers affected by prolonged pressure.

Practice by Chapter

Wound Healing and Care

Practice Questions

Surgical Infections

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Fluid and Electrolyte Management

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Nutrition in Surgical Patients

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Hemostasis and Blood Transfusion

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Surgical Instruments and Equipment

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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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