General Surgery Principles Practice Questions

Q: Which of the following is not done in the treatment of ankylosis?

High condylar shave. **Explanation:** The primary objective in treating **Temporomandibular Joint (TMJ) ankylosis** is to create a functional gap and prevent re-fusion. The standard surgical protocol is **Gap Arthroplasty** or **Interpositional Arthroplasty**. **Why "High Condylar Shave" is the correct answer:** A high condylar shave (or high condylectomy) involves removing only the superior portion of the condylar head. This procedure is indicated for **Condylar Hyperplasia** or early-stage internal derangement, not ankylosis. In ankylosis, there is a dense bony or fibrous mass obliterating the joint space; a mere "shave" is insufficient to release the fusion and would lead to immediate recurrence. Instead, a radical excision of the ankylotic mass (at least 1–1.5 cm gap) is required. **Analysis of other options:** * **Repositioning of temporal fascia:** This is a form of **Interpositional Arthroplasty**. Placing a barrier (like the temporalis muscle/fascia) between the osteotomy sites is crucial to prevent re-ankylosis. * **Ipsilateral coronoidectomy:** Often, the coronoid process becomes elongated or tethered in chronic ankylosis. Removing it on the affected side is a standard step to achieve an intraoperative mouth opening of >35mm. * **Contralateral coronoidectomy:** If the mouth opening remains inadequate after ipsilateral surgery, the contralateral coronoid process must be removed, as it may be preventing the mandible from dropping due to chronic disuse atrophy and fibrosis. **NEET-PG High-Yield Pearls:** * **Kaban’s Protocol:** The gold standard surgical sequence for TMJ ankylosis. * **Most common cause:** Trauma (especially undiagnosed condylar fractures) is the #1 cause worldwide; infections are the #2 cause. * **Sawhney’s Classification:** Used to grade the severity of TMJ ankylosis (Type I to IV). * **Post-op care:** Aggressive physiotherapy is the most critical factor in preventing relapse.

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: Menghini's needle is used for which of the following procedures?

Liver biopsy. **Explanation:** The **Menghini needle** is a specialized instrument designed specifically for **percutaneous liver biopsy** using the "one-second" suction technique. The underlying medical concept is to minimize the time the needle remains within the liver parenchyma to reduce the risk of complications, such as bleeding or capsular tearing, which can occur due to respiratory excursions. The needle features a thin wall and a "blocker" or "stop" mechanism that prevents the aspirated tissue core from being sucked into the syringe, ensuring a high-quality cylindrical specimen. **Analysis of Incorrect Options:** * **A. Pleural aspiration:** Typically performed using a **Veress needle** (for inducing pneumothorax) or a standard wide-bore needle/cannula. * **B. Lumbar puncture:** Uses a **Spinal needle** (e.g., Quincke, Whitacre, or Sprotte needles), which are designed to atraumatically puncture the dura mater. * **C. Kidney biopsy:** Most commonly performed using a **Vim-Silverman needle** or a modern automated **Tru-Cut biopsy needle** to obtain a core of renal tissue. **Clinical Pearls for NEET-PG:** * **Vim-Silverman Needle:** Historically used for liver and kidney biopsies but largely replaced by Tru-Cut needles for better yield. * **Tru-Cut Needle:** The gold standard for "core" biopsies of solid organs (breast, prostate, kidney). * **Jamshidi Needle:** The classic needle used for **Bone Marrow Trephine Biopsy**. * **Abrams Needle:** Specifically used for **Pleural Biopsy**.

Q: Skin loss extending to fascia, muscle, and bone belongs to which grade of pressure sore?

Grade 4. ### Explanation Pressure sores (decubitus ulcers) are staged based on the depth of tissue damage using the **NPUAP (National Pressure Ulcer Advisory Panel)** classification. **Why Grade 4 is Correct:** **Grade 4** is characterized by **full-thickness tissue loss** with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. The hallmark of this stage is the extension of the injury into deep supporting structures (fascia, muscle, or bone), often making osteomyelitis a potential complication. **Analysis of Incorrect Options:** * **Grade 1:** Intact skin with **non-blanchable erythema**, usually over a bony prominence. The skin is not broken. * **Grade 2:** Partial-thickness loss of dermis. It presents as a shallow open ulcer with a red-pink wound bed or as an intact/ruptured **serum-filled blister**. * **Grade 3:** Full-thickness tissue loss. Subcutaneous fat may be visible, but **bone, tendon, or muscle are NOT exposed**. It may include undermining and tunneling. * **Grade 5:** This is not a standard NPUAP stage. However, some older classifications or specific systems refer to "Unstageable" (depth obscured by slough/eschar) or "Deep Tissue Injury." **Clinical Pearls for NEET-PG:** * **Most common site:** Sacrum (overall), followed by the ischial tuberosity and greater trochanter. * **Pathophysiology:** Occurs when external pressure exceeds **capillary filling pressure (32 mmHg)**, leading to ischemia and necrosis. * **Management:** * Grade 1 & 2: Conservative (pressure relief, dressings). * Grade 3 & 4: Often require surgical debridement and reconstructive flaps (e.g., Rotation flaps or Myocutaneous flaps). * **Prevention:** Frequent repositioning (every 2 hours) and use of air-fluidized beds.

Q: Pascal's law is utilized in which technique of hernia repair?

Stoppa's preperitoneal repair. ### Explanation **Correct Answer: B. Stoppa's preperitoneal repair** **Underlying Concept:** Pascal’s Law states that pressure applied to a confined fluid is transmitted equally in all directions. In the context of hernia surgery, Stoppa’s repair (Giant Prosthetic Reinforcement of the Visceral Sac - GPRVS) utilizes this principle by placing a large mesh in the **preperitoneal space**. When intra-abdominal pressure increases (due to coughing or straining), the pressure is transmitted equally across the large mesh. This force effectively presses the mesh more firmly against the posterior aspect of the abdominal wall, using the body's own internal pressure to keep the "plug" in place and prevent herniation. **Why Incorrect Options are Wrong:** * **A. Lichtenstein mesh repair:** This is a "tension-free" repair where the mesh is placed **onlay** (over the transversalis fascia). It relies on mechanical strength and fibrosis rather than Pascal’s Law. * **C. Bassini's repair:** A traditional tissue-based repair involving the sutured apposition of the conjoint tendon to the inguinal ligament. It creates tension and does not involve the preperitoneal physics of Pascal’s Law. * **D. Darning repair:** A tension-free tissue repair using continuous nylon sutures to create a "lattice" or "darn" between the conjoint tendon and inguinal ligament. **High-Yield Clinical Pearls for NEET-PG:** * **Stoppa’s Repair** is the procedure of choice for **bilateral recurrent hernias** or complex multi-focal hernias (e.g., "bilateral disaster" hernias). * The mesh used in Stoppa’s repair is placed in the **Space of Bogros**. * **Nyhus Classification:** Stoppa’s repair is typically indicated for Type IV hernias (recurrent). * **Key Anatomical Landmark:** The "Triangle of Doom" and "Triangle of Pain" are critical landmarks in preperitoneal/laparoscopic repairs to avoid nerve and vascular injury.

Q: Which of the following is a common tumor of the anterior mediastinum?

Thymoma. The mediastinum is anatomically divided into compartments, each characterized by specific resident structures and associated pathologies. The **anterior mediastinum** (the space between the sternum and the pericardium) is the most common site for mediastinal masses. ### **Explanation of Options** * **A. Thymoma (Correct):** Thymoma is the most common primary tumor of the anterior mediastinum in adults. It originates from the epithelial cells of the thymus. Other common anterior mediastinal masses are often remembered by the **"4 Ts" mnemonic**: **T**hymoma, **T**eratoma (and other Germ Cell Tumors), **T**errible Lymphoma, and **T**hyroid (Retrosternal Goiter). * **B. Neurogenic Tumor:** These are the most common tumors of the **posterior mediastinum**. They arise from peripheral nerves (e.g., Schwannoma, Neurofibroma) or the sympathetic chain (e.g., Ganglioneuroma). * **C. Lymphoma:** While lymphoma can occur in the anterior mediastinum (as part of the 4 Ts), it is generally considered the second most common after thymoma. In the context of "most common primary tumor," Thymoma is the preferred answer. * **D. Meningocele:** This is a rare cystic lesion found in the **posterior mediastinum**, often associated with vertebral anomalies. ### **High-Yield Clinical Pearls for NEET-PG** * **Myasthenia Gravis Association:** Approximately 30–45% of patients with thymoma have Myasthenia Gravis. Conversely, only 10–15% of patients with Myasthenia Gravis have a thymoma (though 65% have thymic hyperplasia). * **Imaging Gold Standard:** Contrast-Enhanced Computed Tomography (CECT) is the investigation of choice for evaluating mediastinal masses. * **Age Factor:** In children, neurogenic tumors (posterior) are more common, whereas in adults, thymomas (anterior) predominate. * **Surgical Approach:** Most anterior mediastinal tumors are approached via a **median sternotomy**, while posterior tumors are approached via **thoracotomy**.

Q: Sistrunk operation is the preferred treatment for which of the following conditions?

Thyroglossal cyst. **Explanation:** The **Sistrunk operation** is the gold-standard surgical procedure for a **Thyroglossal cyst**. The underlying medical concept is based on the embryological descent of the thyroid gland. The thyroglossal duct extends from the *foramen caecum* at the base of the tongue to the thyroid's final position. Crucially, this duct is intimately associated with the **hyoid bone**, often passing through or just behind it. To prevent the high rate of recurrence (approx. 50% with simple excision), the Sistrunk procedure involves: 1. Excision of the cyst. 2. Removal of the **central portion of the hyoid bone**. 3. Excision of a core of muscle/tissue up to the foramen caecum. **Analysis of Incorrect Options:** * **A & B (Retrosternal and Endemic Goiter):** These are thyroid parenchymal diseases. Treatment usually involves medical management or various forms of thyroidectomy (e.g., Total or Subtotal Thyroidectomy), not Sistrunk’s. * **D (Adrenal Incidentaloma):** This is an asymptomatic adrenal mass found on imaging. Management depends on size and functional status, typically involving observation or laparoscopic adrenalectomy. **Clinical Pearls for NEET-PG:** * **Most common site:** Subhyoid (infrahyoid). * **Clinical sign:** The cyst moves upward on **protrusion of the tongue** (due to attachment to the foramen caecum) and on deglutition. * **Complication:** The most common malignancy arising in a thyroglossal cyst is **Papillary Thyroid Carcinoma**. * **Pre-op must-do:** Always perform an ultrasound to ensure a normal thyroid gland is present in the neck; the cyst may contain the only functioning thyroid tissue (ectopic thyroid).

Question 1

Rectal examination should not be done in which of the following conditions?

Accepted Answer

Anal fissure

Answer

Fistula in ano

Answer

Prolapsed piles with bleeding

Answer

Anal stenosis

Question 2

Which of the following is not done in the treatment of ankylosis?

Accepted Answer

High condylar shave

Answer

Repositioning of temporal fascia

Answer

Ipsilateral coronoidectomy

Answer

Contralateral coronoidectomy

Question 3

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 4

Menghini's needle is used for which of the following procedures?

Accepted Answer

Liver biopsy

Answer

Pleural aspiration

Answer

Lumbar puncture

Answer

Kidney biopsy

Question 5

Perirectal abscess drainage belongs to which category of surgical procedures?

Accepted Answer

Contaminated surgery

Answer

Clean surgery

Answer

Clean-contaminated surgery

Answer

Dirty surgery

Question 6

Skin loss extending to fascia, muscle, and bone belongs to which grade of pressure sore?

Accepted Answer

Grade 4

Answer

Grade 2

Answer

Grade 3

Answer

Grade 5

Question 7

What is the true relationship of the sac in a femoral hernia with the pubic tubercle?

Accepted Answer

Below and lateral

Answer

Above and lateral

Answer

Above and medial

Answer

Below and medial

Question 8

Pascal's law is utilized in which technique of hernia repair?

Accepted Answer

Stoppa's preperitoneal repair

Answer

Lichtenstein mesh repair

Answer

Bassini's repair

Answer

Darning repair

Question 9

Which of the following is a common tumor of the anterior mediastinum?

Accepted Answer

Thymoma

Answer

Neurogenic tumor

Answer

Lymphoma

Answer

Meningocele

Question 10

Sistrunk operation is the preferred treatment for which of the following conditions?

Accepted Answer

Thyroglossal cyst

Answer

Retrosternal goiter

Answer

Endemic goiter

Answer

Adrenal incidentaloma

General Surgery Principles — MCQs

General Surgery Principles — MCQs

On this page

Practice by Chapter

Want unlimited practice?