General Surgery Principles Practice Questions

Q: Negative pressure dressing is used for which of the following indications?

Chronic non-healing diabetic ulcer. **Explanation:** **Negative Pressure Wound Therapy (NPWT)**, also known as Vacuum-Assisted Closure (VAC), is a gold-standard modality for managing complex wounds. **Why Option B is Correct:** NPWT is highly effective for **chronic non-healing diabetic ulcers** because it works through several mechanisms: * **Macro-strain:** Draws wound edges together, facilitating primary closure. * **Micro-strain:** Creates mechanical tension at the cellular level, stimulating angiogenesis and the formation of healthy **granulation tissue**. * **Exudate Management:** Continuously removes excess interstitial fluid and bacteria, reducing localized edema and improving capillary blood flow. **Why Other Options are Incorrect:** * **A. Removal of eschar:** NPWT is not a debridement tool. Wounds must be surgically debrided of all necrotic tissue and eschar before application; otherwise, the vacuum cannot reach the viable tissue. * **C. Unexplored fistulas:** NPWT is contraindicated in unexplored or non-enteric fistulas because the suction can worsen the tract or cause organ damage. * **D. Untreated osteomyelitis:** NPWT should not be applied over active, untreated bone infections as it may trap the infection and lead to sepsis. The infection must be treated with antibiotics and debridement first. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Malignancy in the wound, untreated osteomyelitis, exposed vital organs/vessels, and necrotic tissue with eschar. * **Pressure Settings:** Usually maintained between **-75 mmHg to -125 mmHg** (continuous or intermittent). * **Key Benefit:** It significantly reduces the frequency of dressing changes and prepares the wound bed for subsequent skin grafting or flaps.

Q: Hydatid cyst occurs most commonly in which organ?

Liver. **Explanation:** Hydatid disease is a parasitic infection caused by the larval stage of **Echinococcus granulosus**. The life cycle involves dogs as definitive hosts and sheep/cattle as intermediate hosts. Humans are accidental intermediate hosts. **Why Liver is the correct answer:** The primary route of infection is the ingestion of eggs (oncospheres) via contaminated food or water. Once ingested, the eggs hatch in the duodenum, and the larvae penetrate the intestinal mucosa to enter the **portal venous system**. Since the liver acts as the first major filter for portal blood, it is the most common site of involvement, accounting for approximately **70-75%** of cases. The right lobe is more frequently affected than the left. **Why other options are incorrect:** * **Lung (Option A):** This is the second most common site (15-25%). Larvae reach the lungs if they bypass the hepatic filter and enter the systemic circulation via the hepatic veins and inferior vena cava. In children, the lungs are relatively more common than in adults. * **Spleen (Option C):** Splenic involvement is rare (2-3%) and usually occurs via systemic dissemination or direct spread. * **Brain (Option D):** Cerebral hydatidosis is very rare (<1%) and typically presents with signs of increased intracranial pressure. **High-Yield Clinical Pearls for NEET-PG:** * **Pathognomonic Sign:** "Water lily sign" (detached endocyst membrane) on imaging. * **Serology:** ELISA is the screening test of choice; Casoni’s test is now obsolete. * **Treatment:** **PAIR** (Puncture, Aspiration, Injection of scolicidal agent, Re-aspiration) is used for specific WHO stages. * **Scolicidal agents:** Hypertonic saline (most common) or Cetrimide. **Formalin is no longer used** due to the risk of sclerosing cholangitis. * **Medical Management:** Albendazole is the drug of choice, often started pre-operatively to reduce cyst tension and prevent anaphylaxis from spillage.

Q: Reactionary hemorrhage occurs after extraction because of which of the following?

High blood pressure. **Explanation:** **Reactionary hemorrhage** is defined as bleeding that occurs within **24 hours** (usually 4–6 hours) following a surgical procedure or trauma. The underlying pathophysiology involves the **recovery of blood pressure** to normal or high levels as the effects of anesthesia (which often contains vasoconstrictors like adrenaline) wear off. During surgery, hypotension or local vasoconstriction may prevent bleeding from small vessels. As the patient’s blood pressure rises post-operatively or the vasoconstrictor effect diminishes, these small vessels dilate, or "clots are blown off," leading to reactionary hemorrhage. Therefore, **High blood pressure** is a primary systemic factor that triggers this event. **Analysis of Incorrect Options:** * **A. Broken roots:** While a retained root tip can cause delayed healing or infection, it is not a primary cause of acute reactionary hemorrhage. * **C. Sharp interdental septum:** This may cause irritation or localized pain but does not typically cause significant post-operative bleeding. * **D. Gingival laceration:** This would typically cause **Primary hemorrhage** (bleeding occurring at the time of surgery) rather than reactionary hemorrhage. **High-Yield NEET-PG Pearls:** 1. **Primary Hemorrhage:** Occurs at the time of surgery (due to vessel injury). 2. **Reactionary Hemorrhage:** Occurs within 24 hours (due to rise in BP/slippage of ligatures). 3. **Secondary Hemorrhage:** Occurs 7–14 days post-surgery (classically due to **infection** eroding a vessel wall). 4. **Management:** For reactionary hemorrhage in dental extraction, initial management includes local pressure, suturing, or hemostatic agents (like Gelfoam); systemic hypertension must be controlled.

Q: In diabetic foot, which type of amputation is contraindicated?

Syme's amputation. **Explanation:** The correct answer is **Syme’s amputation**. **Why Syme’s Amputation is Contraindicated:** Syme’s amputation is a disarticulation of the ankle joint with the removal of the malleoli and the preservation of the heel pad. In diabetic patients, this procedure is generally contraindicated due to **peripheral arterial disease (PAD)** and **microangiopathy**. The success of a Syme’s amputation depends entirely on the viability and blood supply of the posterior tibial artery to the heel pad. Since diabetic patients often have calcified vessels and poor distal perfusion, the heel pad frequently fails to heal, leading to necrosis, infection, and the need for a higher level of amputation. Additionally, diabetic neuropathy can lead to "heel pad migration," making the stump unstable for weight-bearing. **Analysis of Other Options:** * **Ray Amputation:** Commonly performed in diabetics for localized gangrene of a toe and its corresponding metatarsal head. It is indicated if the infection is limited. * **Forefoot (Transmetatarsal) Amputation:** A viable option if the gangrene involves multiple toes but the midfoot has adequate perfusion. * **Below Knee Amputation (BKA):** This is the most common major amputation in diabetics. It is preferred over Syme’s because the vascularity at the calf level is usually superior, ensuring better wound healing and excellent prosthetic fitting. **Clinical Pearls for NEET-PG:** * **Gold Standard for Diabetic Foot Assessment:** The **Wagner Classification** is used to grade the severity of the ulcer. * **Most common site for diabetic foot ulcer:** Plantar aspect of the first metatarsophalangeal joint. * **Vascularity Check:** An **Ankle-Brachial Index (ABI)** < 0.5 or a toe pressure < 30 mmHg indicates poor healing potential for distal amputations. * **Syme’s Amputation** is ideally suited for **trauma** in non-diabetic young patients with good vascularity.

Q: Which of the following wounds is not typically considered untidy?

Incised wound. ### Explanation In surgical practice, wounds are broadly classified into **tidy** and **untidy** based on the mechanism of injury, the state of the tissue margins, and the presence of contamination. **1. Why "Incised Wound" is the Correct Answer:** An **incised wound** is the classic example of a **tidy wound**. It is caused by a sharp object (like a scalpel or glass) resulting in clean-cut, linear edges with minimal soft tissue damage. Because the blood supply to the wound edges remains intact and there is negligible devitalized tissue, these wounds can usually be closed primarily (Primary Intention) with excellent healing prospects. **2. Analysis of Incorrect Options (Untidy Wounds):** Untidy wounds are characterized by irregular edges, significant tissue destruction, and high contamination. * **Crushed Wound:** Caused by blunt force, leading to extensive deep tissue necrosis and impaired vascularity. * **Avulsed Wound:** Involves the tearing away of tissue layers (e.g., degloving), often compromising the blood supply to the skin flaps. * **Lacerated Wound:** Results from blunt trauma or shearing, producing jagged, irregular edges and often containing debris. **3. NEET-PG Clinical Pearls:** * **Management Difference:** Tidy wounds (Incised) can be closed immediately. Untidy wounds require thorough **debridement** (conversion of an untidy wound into a tidy one) before closure is considered. * **Rankin’s Classification:** Remember that "Untidy" wounds often have "the four Cs" of non-viable muscle: dark **C**olor, soft **C**onsistency, lack of **C**apillary bleeding, and failure to **C**ontract. * **High-Yield Fact:** A wound is considered "infected" if it contains $>10^5$ organisms per gram of tissue, a common complication in neglected untidy wounds.

Q: Which one of the following is a muscle-splitting incision?

Lanz. **Explanation:** The correct answer is **Lanz**, which is a classic example of a **muscle-splitting incision**. In surgery, muscle-splitting (or gridiron) incisions involve separating the muscle fibers along their natural direction rather than cutting across them. This preserves the integrity of the abdominal wall and results in better healing and less postoperative pain. * **Lanz Incision:** This is a transverse skin incision made at McBurney’s point, used primarily for appendectomy. It follows the Langer’s lines (skin tension lines) for a better cosmetic result. Like the McBurney (gridiron) incision, the underlying external oblique, internal oblique, and transversus abdominis muscles are split along their fibers. * **Kocher’s Incision:** This is a **muscle-cutting** subcostal incision used for open cholecystectomy or biliary surgery. The rectus abdominis muscle is divided. * **Rutherford-Morris (Rutherford-Morison) Incision:** This is an oblique muscle-cutting incision in the iliac fossa, commonly used for kidney transplants or access to the ureters. It involves cutting the oblique muscles. * **Pfannenstiel Incision:** This is a transverse incision used in pelvic surgery (e.g., C-sections). While the skin and rectus sheath are opened transversely, the rectus muscles are retracted laterally rather than split along their fibers; it is categorized as a **muscle-retracting** incision. **High-Yield Clinical Pearls for NEET-PG:** * **McBurney’s Incision:** The original muscle-splitting incision for appendectomy; it is oblique, whereas Lanz is transverse. * **Battle’s Incision:** A paramedian incision where the rectus muscle is retracted medially (muscle-retracting). * **Sanders’ Incision:** A variation of the Kocher’s incision used for better exposure in obese patients. * **Key Concept:** Muscle-splitting incisions (Lanz/McBurney) have a lower incidence of incisional hernia compared to muscle-cutting incisions.

Q: Acute paronychia is treated by which of the following procedures?

Incision and drainage. **Explanation:** **Acute paronychia** is a common localized infection of the lateral or proximal nail fold, most frequently caused by *Staphylococcus aureus*. The primary pathology involves a collection of pus (abscess) between the nail plate and the surrounding soft tissue. **Why Incision and Drainage (I&D) is correct:** The gold standard for treating any fluctuant abscess is **Incision and Drainage**. In acute paronychia, once suppuration (pus formation) occurs, conservative management with warm soaks or antibiotics is insufficient. An incision is made directly over the area of maximum fluctuation or along the nail fold (eponychium) to evacuate the pus, providing immediate pain relief and preventing the spread of infection to the nail bed or pulp space (felon). **Analysis of Incorrect Options:** * **B. Lifting the paronychium:** While a blunt probe can sometimes be used to separate the nail fold from the nail plate to release pus, it is considered a technique of drainage rather than a standalone procedure. Formal I&D is the definitive surgical principle. * **C. Partial nail excision:** This is typically reserved for cases where the infection has tracked underneath the nail plate (subungual abscess), but it is not the primary treatment for simple paronychia. * **D. Total nail excision:** This is an over-treatment for acute paronychia. It is generally indicated for chronic fungal infections or severe, recurrent ingrown toenails (onychocryptosis). **Clinical Pearls for NEET-PG:** * **Most common organism:** *Staphylococcus aureus* (Acute); *Candida albicans* (Chronic). * **Chronic Paronychia:** Defined as lasting >6 weeks; usually due to irritants/moisture. Treatment is avoidance of triggers and topical steroids (not antibiotics). * **Eponychia:** If the infection involves the entire proximal nail fold. * **Run-around abscess:** When paronychia extends from one lateral fold to the other across the base of the nail.

Question 1

Negative pressure dressing is used for which of the following indications?

Accepted Answer

Chronic non-healing diabetic ulcer

Answer

Removal of eschar

Answer

Unexplored fistulas

Answer

Untreated osteomyelitis

Question 2

Hydatid cyst occurs most commonly in which organ?

Accepted Answer

Liver

Answer

Lung

Answer

Spleen

Answer

Brain

Question 3

Reactionary hemorrhage occurs after extraction because of which of the following?

Accepted Answer

High blood pressure

Answer

Broken roots

Answer

Sharp interdental septum

Answer

Gingival laceration

Question 4

A Grade III wound is considered contaminated if it is:

Accepted Answer

A wound contaminated with gross fecal material spillage

Answer

An appendicular perforation

Answer

A wound in the urinary tract without unusual contamination

Answer

A surgical site with no unusual contamination

Question 5

All of the following are true about hernia surgery except:

Accepted Answer

Surgery should not be done unless the patient becomes symptomatic.

Answer

Hernia in children is treated with herniotomy.

Answer

Absorbable mesh should not be used for surgery.

Answer

Surgery can be done using laparoscopy.

Question 6

In diabetic foot, which type of amputation is contraindicated?

Accepted Answer

Syme's amputation

Answer

Ray amputation

Answer

Forefoot amputation

Answer

Below knee amputation

Question 7

Which of the following wounds is not typically considered untidy?

Accepted Answer

Incised wound

Answer

Crushed wound

Answer

Avulsed wound

Answer

Lacerated wound

Question 8

Which one of the following is a muscle-splitting incision?

Accepted Answer

Lanz

Answer

Kocher's

Answer

Rutherford-Morris

Answer

Pfannensteil

Question 9

Which approach is safest for draining an axillary abscess?

Accepted Answer

Floor

Answer

Medial

Answer

Posterior

Answer

Lateral

Question 10

Acute paronychia is treated by which of the following procedures?

Accepted Answer

Incision and drainage

Answer

Lifting the paronychium

Answer

Partial nail excision

Answer

Total nail excision

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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