General Surgery Principles Practice Questions

Q: Which of the following is NOT part of personal protective equipment?

Lab coat. In the context of surgical practice and infection control, **Personal Protective Equipment (PPE)** refers to specialized clothing or equipment worn by healthcare workers to protect themselves from infectious materials or bodily fluids. ### Why "Lab Coat" is the Correct Answer While a lab coat is a common piece of professional attire, it is **not** classified as PPE in a clinical or surgical setting. Standard lab coats are typically made of permeable cotton or polyester, which can soak up fluids and harbor pathogens, potentially acting as a **fomite**. In contrast, PPE must provide a barrier. In high-risk or surgical environments, a lab coat is replaced by a **fluid-resistant sterile gown**, which is true PPE. ### Analysis of Other Options * **Gloves (B):** These are the most essential component of PPE, protecting the hands from blood-borne pathogens and preventing the cross-contamination of surgical sites. * **Face Mask (A):** Masks protect the wearer’s mucous membranes (nose and mouth) from splashes and prevent the transmission of respiratory droplets to the patient. * **Goggles (D):** Eye protection is a critical part of "Standard Precautions" to prevent conjunctival exposure to blood or body fluid splashes during procedures. ### NEET-PG Clinical Pearls * **Standard Precautions:** The principle that all blood and body fluids are treated as potentially infectious. PPE is the cornerstone of these precautions. * **Donning Sequence (Putting on):** Gown → Mask → Goggles/Face Shield → Gloves. * **Doffing Sequence (Taking off):** Gloves → Goggles → Gown → Mask (Gloves are removed first as they are the most contaminated). * **N95 Masks:** Required specifically for **aerosol-generating procedures** (e.g., intubation, bronchoscopy) or when dealing with airborne infections like Tuberculosis or COVID-19.

Q: What is the ideal treatment of alveolar osteitis after dental extraction?

Debridement of socket and sedative dressing. **Explanation:** **Alveolar Osteitis**, commonly known as **"Dry Socket,"** is a painful condition occurring 3–5 days post-extraction due to the premature lysis or loss of the blood clot. This exposes the underlying alveolar bone to oral fluids and bacteria, leading to localized osteitis. **Why Option C is Correct:** The primary goal of treatment is **pain management** and promoting secondary intention healing. The standard protocol involves: 1. **Gentle Debridement:** Irrigating the socket with warm saline to remove food debris and necrotic tissue. 2. **Sedative Dressing:** Placing a medicated dressing (typically **Zinc Oxide Eugenol** or Alvogyl) into the socket. Eugenol acts as a local anesthetic and obtundent, providing immediate relief from the characteristic radiating pain. **Why Other Options are Incorrect:** * **A & B (Antibiotics):** Dry socket is primarily a physical loss of the clot leading to inflammation, not a systemic or localized infection requiring antibiotics. They do not provide pain relief or accelerate healing in this context. * **D (Curettage):** This is **contraindicated**. Aggressive curettage to induce bleeding can spread the localized inflammation into the deeper bone, potentially causing true osteomyelitis. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Smoking (most common), oral contraceptives, traumatic extraction, and mandibular third molar extractions. * **Clinical Feature:** Severe, throbbing pain radiating to the ear, accompanied by a foul odor (halitosis) and an empty-looking socket. * **Pathophysiology:** Increased **fibrinolysis** (plasminogen conversion to plasmin) which dissolves the clot. * **Management:** It is a self-limiting condition; treatment is purely symptomatic.

Q: Which type of transplantation requires all cellular components to be irradiated prior to transfusion?

Bone marrow. **Explanation:** The correct answer is **Bone marrow (C)**. The underlying medical concept is the prevention of **Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)**. In bone marrow transplantation, the recipient is severely immunocompromised due to conditioning regimens (chemotherapy/radiation). If non-irradiated blood products are transfused, viable donor T-lymphocytes can recognize the recipient's HLA antigens as foreign and mount an immune attack against the host's tissues (skin, liver, and bone marrow). Since the recipient’s immune system is suppressed, it cannot reject these donor cells. **Irradiation** (usually 25-30 Gy) inactivates donor T-lymphocytes by causing DNA cross-linking, preventing them from proliferating without affecting the function of red cells or platelets. **Why other options are incorrect:** * **Heart, Liver, and Lung (A, B, D):** While these are solid organ transplants requiring immunosuppression, the risk of TA-GVHD is significantly lower compared to hematopoietic stem cell transplants. Standard protocols for solid organ transplants do not routinely mandate irradiation of all cellular components unless the patient is undergoing specific high-intensity T-cell depleting therapy (like ATG). **High-Yield Clinical Pearls for NEET-PG:** * **Indications for Irradiated Blood:** Bone marrow/Stem cell transplant recipients, patients with Hodgkin lymphoma, intrauterine transfusions, and directed donations from first-degree relatives. * **TA-GVHD Mortality:** Unlike chronic GVHD, TA-GVHD is nearly always fatal (mortality >90%) due to profound bone marrow aplasia. * **Shelf Life:** Irradiation shortens the shelf life of RBCs to 28 days due to increased potassium leakage from the cells.

Q: Cock's peculiar tumour is described as:

An infected sebaceous cyst. **Explanation:** **Cock’s Peculiar Tumour** is a clinical entity where a long-standing **sebaceous cyst of the scalp** undergoes infection and ulceration. The correct answer is **Option A**. 1. **Why Option A is Correct:** When a sebaceous cyst on the scalp becomes infected, it can rupture and form an ulcerated, exuberant mass of granulation tissue. This proliferative growth mimics a fungating squamous cell carcinoma (hence "peculiar"), but it remains a benign, inflammatory complication of a sebaceous cyst. 2. **Why Other Options are Incorrect:** * **Option B & C:** Although it clinically resembles a malignant or metastatic lesion due to its raw, fungating appearance, it is pathologically benign. It does not arise from malignant transformation or distant spread. * **Option D:** While infection is present, it is localized to the dermis and subcutaneous tissue; it is not typically associated with underlying bone infection (osteomyelitis). **High-Yield Clinical Pearls for NEET-PG:** * **Common Site:** Almost exclusively found on the **scalp**. * **Clinical Appearance:** It presents as a foul-smelling, vascular, and ulcerated swelling that looks like a "cauliflower." * **Differential Diagnosis:** Must be differentiated from **Squamous Cell Carcinoma (SCC)**. The presence of a punctum or a history of a slow-growing cyst favors Cock’s tumour. * **Management:** Wide local excision is the treatment of choice. * **Pathology:** Histology shows inflamed granulation tissue and remnants of the sebaceous cyst wall; it is **not** a true neoplasm.

Q: Facial nerve injury occurs during parotid surgery. What is the best management?

Immediate repair. **Explanation:** The facial nerve is the most critical structure encountered during parotidectomy. If the nerve is accidentally transected during surgery, **Immediate primary repair** (Option A) is the gold standard of management. **Why Immediate Repair is Correct:** 1. **Anatomical Alignment:** The nerve ends are fresh, easily identifiable, and have not yet retracted or been obscured by postoperative scarring and fibrosis. 2. **Distal Stimulation:** For up to 72 hours post-injury, the distal segment of the nerve can still be stimulated using a nerve stimulator (due to Wallerian degeneration not being complete), making it easier to locate the distal branches. 3. **Better Outcomes:** Primary neurorrhaphy (end-to-end anastomosis) or immediate cable grafting (using the great auricular or sural nerve) provides the best functional recovery. **Why Other Options are Incorrect:** * **Option B & C:** Delaying repair (delayed primary or secondary repair) leads to stump retraction, muscle atrophy, and dense fibrosis, which significantly complicates the surgery and worsens the prognosis for facial symmetry. * **Option D:** While complex cases may require expertise, "doing nothing" is negligent. The best window for repair is intraoperative. **NEET-PG High-Yield Pearls:** * **Most common nerve injured** in parotid surgery: Facial nerve (specifically the marginal mandibular branch). * **Most common benign tumor:** Pleomorphic adenoma (requires Superficial Parotidectomy). * **Landmarks to identify Facial Nerve:** Tragal pointer (nerve is 1cm deep and slightly anterior/inferior), Tympanomastoid fissure, and the Posterior belly of the digastric muscle. * **Frey’s Syndrome:** A late complication of parotidectomy due to aberrant regeneration of auriculotemporal nerve fibers. Diagnosis: Minor’s Starch-Iodine test.

Question 1

What is extrapleural pneumonectomy?

Accepted Answer

Removal of an affected lung with its pleura and part of the diaphragm

Answer

Removal of one lobe of the lung

Answer

Removal of a complete lung

Answer

Removal of the pleura of one lung

Question 2

Splenosis means

Accepted Answer

Rupture of the spleen and distribution of its tissue on the peritoneum

Answer

Infection of the spleen

Answer

Presence of an accessory spleen

Answer

A non-functioning spleen

Question 3

Which of the following is NOT part of personal protective equipment?

Accepted Answer

Lab coat

Answer

Face mask

Answer

Gloves

Answer

Goggles

Question 4

All of the following are true about primary bacterial peritonitis, EXCEPT:

Accepted Answer

It usually does not respond to routine antimicrobial therapy.

Answer

Ascitic fluid polymorphonuclear leukocyte (PMN) count > 250 cells/mm³ is diagnostic.

Answer

Microbiology of primary bacterial peritonitis is distinctive.

Answer

Some patients may be totally asymptomatic.

Question 5

Elective splenectomy is indicated in which of the following conditions?

Accepted Answer

Hereditary spherocytosis

Answer

G6PD deficiency

Answer

Beta thalassemia

Answer

Sickle cell anemia

Question 6

What is the ideal treatment of alveolar osteitis after dental extraction?

Accepted Answer

Debridement of socket and sedative dressing

Answer

Topical antibiotics

Answer

Systemic antibiotics

Answer

Curettage to induce fresh bleeding

Question 7

Which type of transplantation requires all cellular components to be irradiated prior to transfusion?

Accepted Answer

Bone marrow

Answer

Heart

Answer

Liver

Answer

Lung

Question 8

Cock's peculiar tumour is described as:

Accepted Answer

An infected sebaceous cyst

Answer

A malignant tumour of the scalp

Answer

A metastatic lesion of the scalp

Answer

An indicator of underlying osteomyelitis

Question 9

What is the most sensitive investigation for acute appendicitis?

Accepted Answer

Computed Tomography (CT)

Answer

Ultrasound (USG)

Answer

Magnetic Resonance Imaging (MRI)

Answer

Abdominal Radiography

Question 10

Facial nerve injury occurs during parotid surgery. What is the best management?

Accepted Answer

Immediate repair

Answer

Repair after 1 week

Answer

Repair after waiting for partial recovery of the nerve

Answer

Do nothing and refer to a higher center

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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