General Surgery Principles Practice Questions

Q: What is the most common organism causing peritonitis?

E. coli. **Explanation:** The most common cause of peritonitis, particularly **secondary peritonitis**, is the translocation of indigenous flora from the gastrointestinal tract following a hollow viscus perforation (e.g., perforated peptic ulcer or appendix). Since the large intestine contains the highest concentration of bacteria, the flora is dominated by Gram-negative aerobes and anaerobes. **Escherichia coli (E. coli)** is the most frequently isolated aerobic organism in these cases, often found in polymicrobial synergy with anaerobes like *Bacteroides fragilis*. **Analysis of Options:** * **B. E. coli (Correct):** It is the leading cause of both secondary peritonitis (due to GI perforation) and Spontaneous Bacterial Peritonitis (SBP) associated with cirrhosis. * **A. Klebsiella:** While a common Gram-negative pathogen in the gut, it is the second most common cause after E. coli. * **C. Staphylococcus aureus:** This is a common cause of peritonitis specifically in patients undergoing **Continuous Ambulatory Peritoneal Dialysis (CAPD)**, where the infection is introduced via the skin/catheter. * **D. Streptococcus:** *Streptococcus pneumoniae* can cause primary peritonitis in children (especially those with nephrotic syndrome), but it is not the most common cause in the general population. **Clinical Pearls for NEET-PG:** * **Most common cause of SBP:** E. coli. * **Most common cause of CAPD peritonitis:** *Staphylococcus epidermidis* (overall) or *Staphylococcus aureus*. * **Most common cause of Post-operative peritonitis:** Often involves multi-drug resistant organisms like *Pseudomonas* or *Enterococcus*. * **Primary Peritonitis (Childhood):** Often associated with *Streptococcus pneumoniae* or Group A *Streptococcus*.

Q: Which of the following is NOT an indication for splenectomy?

Chediak-Higashi syndrome. **Explanation:** The correct answer is **Chediak-Higashi syndrome**. This is an autosomal recessive disorder characterized by a defect in the **LYST gene**, leading to impaired microtubule assembly and giant lysosomal granules. While patients present with partial albinism, recurrent pyogenic infections, and progressive neurological defects, the primary treatment is **Bone Marrow Transplantation**. Splenectomy is not a standard indication as it does not address the underlying phagocytic defect. **Analysis of other options:** * **Hereditary Spherocytosis:** Splenectomy is the **treatment of choice** for moderate to severe cases. It eliminates the site of premature red cell destruction (the splenic cords), thereby curing the anemia and preventing gallstone formation. * **Hairy Cell Leukemia:** While Cladribine is the modern drug of choice, splenectomy is indicated for patients with massive splenomegaly causing discomfort or severe cytopenias (hypersplenism) that do not respond to systemic therapy. * **Immune Thrombocytopenic Purpura (ITP):** Splenectomy is a classic **second-line treatment** for patients who fail corticosteroid therapy. It removes both the primary site of platelet destruction and a major source of anti-platelet antibody production. **Clinical Pearls for NEET-PG:** * **Vaccination:** Post-splenectomy patients must receive vaccinations against encapsulated organisms (*S. pneumoniae, H. influenzae, N. meningitidis*) ideally **2 weeks before** elective surgery or **2 weeks after** emergency surgery. * **Blood Picture:** Look for **Howell-Jolly bodies**, Pappenheimer bodies, and Heinz bodies on a peripheral smear post-splenectomy. * **OPSI:** Overwhelming Post-Splenectomy Infection is most commonly caused by *Streptococcus pneumoniae*.

Q: Which of the following is the primary use of the nasogastric tube depicted?

Gastric drainage. ***Gastric drainage*** - A **nasogastric tube** (Ryle's tube) is primarily designed for **gastric decompression** and drainage of stomach contents. - It helps remove **gastric secretions**, **air**, and **fluid** to prevent distension and aspiration, especially post-operatively. *Common bile duct drainage* - **Bile duct drainage** requires specialized tubes like **T-tubes** or **percutaneous transhepatic cholangiography (PTC)** catheters. - A nasogastric tube cannot reach the **biliary system** as it terminates in the stomach. *Jejunal feeding* - **Jejunal feeding** requires a **nasojejunal tube** or **jejunostomy tube** that extends beyond the **pylorus** into the small intestine. - A standard nasogastric tube ends in the **stomach** and is unsuitable for direct jejunal nutrition. *Pelvic drainage* - **Pelvic drainage** requires **surgical drains** placed directly in the pelvic cavity through the **abdomen** or **perineum**. - A nasogastric tube inserted through the **nose** cannot access pelvic structures anatomically.

Q: Suturing in facial wound injuries should ideally be performed within what timeframe?

6 hours. **Explanation:** The primary concern in wound management is the risk of infection and the "Golden Period" for primary closure. For most traumatic wounds, the standard timeframe for primary suturing is within **6 hours**. **1. Why 6 hours is correct:** This timeframe is based on the bacterial growth curve. After an injury, bacteria contaminate the wound but require time to colonize and multiply to a critical level (typically $>10^5$ organisms per gram of tissue). Within the first 6 hours, the wound is considered "contaminated" but not yet "infected." Primary closure during this window significantly reduces the risk of wound dehiscence and sepsis. **2. Analysis of Incorrect Options:** * **2 & 4 hours (Options A & C):** While suturing earlier is always better for tissue viability, these timeframes are unnecessarily restrictive. The risk of infection does not increase significantly between hours 2 and 6. * **8 hours (Option D):** By 8 hours, the bacterial load often reaches the threshold for clinical infection. Closing a wound after this period (especially on the trunk or limbs) increases the risk of trapping pathogens, leading to abscess formation. **3. Clinical Pearls for NEET-PG:** * **The Exception (Face and Scalp):** Due to the **excellent vascularity** of the face and scalp, the "Golden Period" can often be extended up to **12–24 hours**. However, in standard surgical teaching and general MCQ patterns, 6 hours remains the classic benchmark for primary closure. * **Primary vs. Delayed Primary Closure:** Wounds presenting after 6–8 hours (or heavily soiled wounds) should be managed by **Delayed Primary Closure (Third Intention)**—usually performed 3–5 days later after ensuring the wound is clean. * **Bites:** Human and animal bites are generally not closed primarily (regardless of the timeframe) due to high polymicrobial contamination, except in specific cosmetic areas like the face where loose suturing may be considered.

Q: Tissue adhesive glue contains which of the following substances?

Cyanoacrylate. **Explanation:** **Cyanoacrylate** is the primary component of medical-grade tissue adhesives (e.g., Dermabond). When it comes into contact with moisture on the skin surface, it undergoes an exothermic polymerization reaction, forming a strong, flexible bond that bridges wound edges. In surgery, it is used for closing small, tension-free incisions and as a microbial barrier. **Analysis of Incorrect Options:** * **B. Ethanolamine:** This is a sclerosing agent (Ethanolamine oleate) used primarily in the endoscopic treatment of bleeding esophageal varices, not as a tissue adhesive. * **C. Methacrylate:** Specifically Methyl methacrylate, this is "bone cement." It is used in orthopedic surgery for fixing prosthetic implants to bone but is not used as a topical tissue glue for skin closure. * **D. Polychloroprene:** This is a synthetic rubber (Neoprene) used in the manufacturing of surgical gloves and medical supports; it has no adhesive properties for wound closure. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Polymerization occurs upon contact with hydroxyl ions (water/blood). * **Advantages:** It provides a waterproof seal, acts as a barrier to bacteria, and eliminates the need for suture removal. * **Contraindications:** Do not use on infected wounds, mucosal surfaces, or high-tension areas (like joints) unless reinforced. * **Types:** *Butyl-cyanoacrylate* (faster setting, more brittle) and *Octyl-cyanoacrylate* (stronger, more flexible, preferred for long incisions).

Q: HIPEC is used for?

Treating peritoneal metastasis. **Explanation:** **HIPEC (Hyperthermic Intraperitoneal Chemotherapy)** is a specialized treatment modality used primarily for **peritoneal carcinomatosis** (metastasis to the lining of the abdominal cavity). The procedure involves two main steps: 1. **Cytoreductive Surgery (CRS):** All visible tumor nodules are surgically removed from the abdomen. 2. **Chemotherapy Infusion:** Heated chemotherapy drugs (usually 41°C to 43°C) are circulated within the abdominal cavity for 60–90 minutes. **Why Option C is correct:** The "Hyperthermic" component enhances the cytotoxicity of the chemotherapy and increases drug penetration into any remaining microscopic tumor cells. By delivering the drug directly into the peritoneum, a high local concentration is achieved with minimal systemic toxicity, making it the gold standard for peritoneal surface malignancies (e.g., pseudomyxoma peritonei, mesothelioma, and select cases of colorectal or ovarian cancer). **Why other options are incorrect:** * **Option A:** Bone metastases are typically identified using Technetium-99m MDP bone scans or PET-CT. * **Option B:** Breast cancer screening relies on Mammography (standard) or MRI (high-risk patients). * **Option C:** Tuberculosis (specifically abdominal TB) is diagnosed via imaging (CT), ADA levels in ascitic fluid, or laparoscopy with biopsy. **High-Yield Clinical Pearls for NEET-PG:** * **Sugarbaker’s Procedure:** Another name for the combination of CRS and HIPEC. * **Common Drugs used:** Mitomycin C (Colorectal), Cisplatin/Doxorubicin (Ovarian/Mesothelioma), and Oxaliplatin. * **PCI (Peritoneal Cancer Index):** A scoring system used to determine the extent of peritoneal spread and eligibility for HIPEC. * **Best Prognosis:** HIPEC shows the best outcomes in **Pseudomyxoma Peritonei** (secondary to appendiceal mucinous neoplasms).

Question 1

What are the differentiating features between sepsis and trauma?

Accepted Answer

Energy requirement

Answer

Catabolism

Answer

Insulin resistance

Answer

Fluid loss

Question 2

What is the most common organism causing peritonitis?

Accepted Answer

E. coli

Answer

Klebsiella

Answer

Staphylococcus aureus

Answer

Streptococcus

Question 3

In infection involving the submandibular space when extraoral incision and drainage are necessary, which of the following structures must be divided?

Accepted Answer

Skin, superficial fascia, platysma, masseter muscle, and deep cervical fascia

Answer

Skin only

Answer

Skin and superficial fascia only

Answer

Skin, superficial fascia, platysma, and masseter muscle

Question 4

Which of the following is NOT an indication for splenectomy?

Accepted Answer

Chediak-Higashi syndrome

Answer

Hereditary spherocytosis

Answer

Hairy cell leukemia

Answer

Immune thrombocytopenic purpura (ITP)

Question 5

Which of the following is the primary use of the nasogastric tube depicted?

Accepted Answer

Gastric drainage

Answer

Common bile duct drainage

Answer

Jejunal feeding

Answer

Pelvic drainage

Question 6

Suturing in facial wound injuries should ideally be performed within what timeframe?

Accepted Answer

6 hours

Answer

2 hours

Answer

4 hours

Answer

8 hours

Question 7

True about indirect inguinal hernia?

Accepted Answer

It travels through both superficial and deep inguinal rings.

Answer

It travels through the deep inguinal ring only.

Answer

It travels through the superficial inguinal ring only.

Answer

It occurs through Hesselbach's triangle.

Question 8

Tissue adhesive glue contains which of the following substances?

Accepted Answer

Cyanoacrylate

Answer

Ethanolamine

Answer

Methacrylate

Answer

Polychloroprene

Question 9

HIPEC is used for?

Accepted Answer

Treating peritoneal metastasis

Answer

Identifying bone metastases

Answer

Screening protocol for breast cancer

Answer

Diagnosing tuberculosis

Question 10

Regarding the management of diabetic foot, which of the following statements are TRUE?

Accepted Answer

Strict diabetic control, topical antibiotics, and diabetic ulcers being trophic ulcers are true; venous system involvement and early amputation are false.

Answer

Strict diabetic control, venous system involvement, and topical antibiotics are true; early amputation and trophic ulcers are false.

Answer

All statements are false.

Answer

All statements are true.

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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