General Surgery Principles Practice Questions

Q: All of the following carcinomas are associated with this condition shown in the image except:

Lung carcinoma. The image displays a **Sister Mary Joseph nodule**, which is a **metastatic lesion** to the **umbilicus** from an internal malignancy. The question asks which carcinoma is *not* typically associated with this condition, but the options are missing. To provide a comprehensive explanation, I will list common associations and an example of a type of cancer that is **not** typically associated with a Sister Mary Joseph nodule. ***Lung carcinoma*** - While lung cancer can metastasize widely, the **umbilicus** is a **less common site** for metastasis from lung carcinoma compared to intra-abdominal malignancies. - Metastasis to the umbilicus from lung cancer would typically indicate a **very advanced stage** of disease. *Gastric adenocarcinoma* - **Gastric adenocarcinoma** is one of the most common primary tumors that metastasize to the umbilicus, accounting for a significant percentage of Sister Mary Joseph nodules. - The metastatic spread often occurs via the **peritoneal cavity**, lymphatic system, or directly through contiguous spread. *Colorectal carcinoma* - **Colorectal carcinoma** is another frequent source of metastasis to the umbilicus, especially in advanced stages. - Metastatic cells can travel through the **lymphatic channels** or through **peritoneal seeding** from the primary tumor. *Ovarian carcinoma* - **Ovarian carcinoma** commonly metastasizes within the peritoneal cavity due to its exfoliative nature, making the umbilicus a relatively common site for metastasis. - The spread often involves **peritoneal carcinomatosis**, and the umbilicus can be affected as part of this widespread involvement.

Q: What is the functional capability of the instrument shown in the image?

Used for both cutting and coagulation. ***Used for both cutting and coagulation*** - The image displays a **bipolar electrosurgical forceps**, which is specifically designed to deliver **high-frequency electrical current** for both cutting and coagulating tissue. - The electrical energy is localized between the two tips of the forceps, allowing for precise tissue manipulation with minimal collateral damage and reducing the risk of current spread to other parts of the body. *Used for coagulation* - While this instrument is excellent for **coagulation**, its capabilities extend beyond just stopping bleeding. - It can also be used for **cutting tissue efficiently** by using a different electrical waveform or power setting. *Used for cutting* - This instrument is indeed used for **cutting tissue**, but it also has the critical function of **coagulation**. - Restricting its description to only cutting would be incomplete and overlook its dual utility in surgery. *Cannot be used in patient with artificial valves* - Bipolar electrosurgery is generally considered **safe for patients with pacemakers, ICDs, or artificial valves** because the current is confined between the two tips of the instrument. - This localized current flow **minimizes the risk of interference** with implanted medical devices, unlike monopolar electrosurgery which has a greater risk of current dispersion.

Q: A 60-year-old male came with bleeding per rectum and was diagnosed to have carcinoma colon. The patient underwent extended hemicolectomy. Identify the instrument the surgeon is using: (AIIMS Nov 2016)

Harmonic scalpel. ***Harmonic scalpel*** - The image displays a device with a thin tip and a handpiece featuring activation buttons, consistent with the appearance of a **harmonic scalpel**. - **Harmonic scalpels** use **ultrasonic vibrations** to cut and coagulate tissue simultaneously, minimizing thermal spread and smoke plume, especially useful in delicate dissections during surgery like a hemicolectomy. *Ligasure vessel ligating system* - A **Ligasure device** typically has larger, jaw-like tips designed for **vessel sealing**, which applies pressure and bipolar energy to fuse vessel walls. - The tip shown in the image is too fine for the characteristic **Ligasure** vessel sealing mechanism. *Monopolar cautery* - While a **monopolar cautery** pencil (or **Electrocautery Pencil**) also has a fine tip and control buttons, the pictured device's detailed tip structure and specialized cable suggest it's more advanced than a basic monopolar cautery, which primarily uses electrical current to cut or coagulate. - The distinctive design with a more elongated and precise tip is indicative of ultrasonic rather than electrical cutting. *Hyfrecator* - A **Hyfrecator** is a form of electrocautery primarily used for **desiccation and fulguration** of superficially located tissues, often in dermatology. - It uses a much lower power setting than typical surgical electrocautery and would not be the primary cutting instrument for extensive procedures like a hemicolectomy.

Q: What is the most likely diagnosis based on the image provided? The patient had a snake bite at this site 5 years ago.

Marjolin's ulcer. ***Marjolin's ulcer*** - This is a **squamous cell carcinoma** developing in a chronic wound, burn scar, or chronic inflammatory lesion, often after a long latent period (like the 5 years post-snake bite). The image shows a **fungating, ulcerative lesion** consistent with a malignant transformation in a chronic wound. - The history of a **snake bite 5 years ago** indicates a pre-existing chronic wound site, making Marjolin's ulcer the most probable diagnosis for a subsequent malignant change. *Bazin's ulcer* - Bazin's ulcer, also known as **erythema induratum**, is a chronic, recurrent panniculitis typically affecting the calves of young to middle-aged women. - It is associated with **tuberculosis**, presenting as tender, subcutaneous nodules that can ulcerate, which doesn't match the image or history. *Martorell's ulcer* - This is a form of **ischemic ulcer** caused by severe, uncontrolled hypertension, leading to microangiopathy and skin necrosis, usually on the anterior and lateral aspects of the lower leg. - While it presents as a painful ulcer, it is not typically associated with chronic trauma or previous wounds like a snake bite and lacks the fungating appearance shown. *Meleney's ulcer* - Meleney's ulcer, or **progressive bacterial synergistic gangrene**, is a rare, severe skin infection characterized by painful, undermined ulcers with a necrotic center. - It usually develops post-surgery or trauma and involves a synergistic bacterial infection, which is not suggested by the chronic nature (5 years) or the appearance of the lesion in the image.

Q: A 60-year-old male patient with a history of weight gain and polyuria presents with the following lesion. What is the most possible diagnosis?

Diabetic ulcer. ***Diabetic ulcer*** - The patient's history of **weight gain** and **polyuria** suggests uncontrolled diabetes mellitus, a common cause of foot ulcers. - **Diabetic ulcers** often appear on pressure points of the foot, are typically painless due to neuropathy, and can be complicated by poor wound healing, as seen in the image. *Buruli's ulcer* - Buruli's ulcer is a **necrotizing skin disease** caused by *Mycobacterium ulcerans*, typically found in tropical and subtropical regions. - While it causes large, deep ulcers, the patient's symptoms (weight gain, polyuria) are not characteristic of this infection. *Venous ulcer* - **Venous ulcers** occur due to chronic venous insufficiency and are typically found on the **medial malleolus**, often associated with edema, hyperpigmentation, and lipodermatosclerosis. - The lesion's appearance and location, along with the patient's systemic symptoms, do not align with a classic venous ulcer. *Meleney's ulcer* - **Meleney's ulcer** (also known as progressive bacterial synergistic gangrene) is a rare, painful, and rapidly progressive ulceration of the skin and subcutaneous tissue. - It usually follows surgical procedures or trauma and is characterized by a necrotic center with a spreading red margin, which doesn't fully match the provided image or patient history.

Q: What is shown in the image given below?

Lipoma. ***Lipoma*** - The image displays a soft, mobile, and **well-demarcated subcutaneous mass** on the wrist, which is characteristic of a lipoma. - Lipomas are **benign tumors** composed of mature fat cells and are one of the most common soft tissue tumors, often occurring on the trunk, neck, upper thighs, upper arms, and forearms. *Radial artery aneurysm* - A radial artery aneurysm would typically present as a **pulsatile mass** in the anatomical course of the radial artery, and would often involve symptoms of vascular compression or compromise. - The mass in the image does not visibly appear to be pulsatile, and it is located dorsally, not directly over the radial artery which is more volar. *Liposarcoma* - Liposarcomas are **malignant tumors** that can be difficult to distinguish from lipomas clinically, but they are generally larger, firmer, deeper, and may show rapid growth or cause pain. - While they are composed of fat cells, the visual appearance of this lesion is more consistent with a benign growth. Imaging (MRI) and biopsy would be needed for definitive diagnosis. *Enchondroma* - An enchondroma is a **benign cartilaginous tumor** that arises within the bone, most commonly in the small bones of the hands and feet. - It would not typically present as a visible, soft tissue mass on the surface, but rather as an intraosseous lesion, sometimes causing bone expansion or pathological fractures.

Q: All are correct about the image shown below except:

Grade 5 ulcer. ***Grade 5 ulcer*** - The Wagner grading system for diabetic foot ulcers ranges from 0 to 5. A **Grade 5 ulcer** specifically refers to **extensive gangrene** involving the entire foot, which is not depicted in the image. - The ulcer shown is more consistent with a lesser grade, likely involving full-thickness skin loss but without widespread gangrene. *Neuropathic ulcer* - The image shows a **classic neuropathic ulcer** on the plantar aspect of the foot, characterized by a **punched-out appearance** with surrounding callused skin. - These ulcers are common in diabetic patients due to peripheral neuropathy and repetitive trauma to pressure points. *Hydrocolloid dressings* - **Hydrocolloid dressings** are appropriate for managing wounds that have **minimal to moderate exudate**, as these dressings help create a moist wound environment conducive to healing. - They are often used for neuropathic ulcers that have been debrided and are no longer heavily infected. *MRI to rule out osteomyelitis* - Deep or chronic foot ulcers, especially in diabetic patients, carry a significant risk of **osteomyelitis**, an infection of the bone. - **MRI** is the **most sensitive imaging modality** for detecting osteomyelitis and is crucial for confirming or ruling out bone involvement.

Q: All are true about the lesion shown below except:

Severe itching. ***Severe itching*** - Keloids typically cause symptoms such as **pain**, **tenderness**, and a **burning sensation**, but **severe itching** is not a characteristic feature. - While some itching might occur, it is generally **not the predominant symptom** compared to the other options listed. *Claw like process* - Keloids are well-known for their **claw-like extensions** or finger-like projections that spread beyond the original wound boundaries. - This characteristic growth pattern helps differentiate keloids from hypertrophic scars, which remain within the wound margins. *Develops at vaccination sites* - Keloids have a propensity to form at sites of skin injury, including piercings, surgical incisions, and **vaccination sites**. - This is a common predisposing factor, particularly in individuals with a genetic predisposition to keloid formation. *Collagen bundles are present* - Histologically, keloids are characterized by the presence of **thick, haphazardly arranged collagen bundles** in the dermis. - This excessive and disorganized deposition of collagen is a hallmark of keloid pathology.

Q: Identify these two surgical instruments.

Artery forceps and needle holder. ***Artery forceps and needle holder*** - The instrument on the **left** is an **artery forcep** (e.g., Mixter/right-angle clamp), recognizable by its angled jaws and often used for clamping or dissecting vessels. - The instrument on the **right** is a **needle holder**, characterized by its short, sturdy jaws with serrations (often cross-hatched) designed to firmly grip a needle during suturing. *Thumb forceps and sponge holder* - The instruments shown are **ring-handled clamps with ratchets**, not thumb forceps which are tweezer-like. - A sponge holder (e.g., Foerster clamp) typically has **fenestrated** (ring-shaped) jaws for grasping sponges, which is not depicted. *Sponge holder and Allis forceps* - While one might resemble a variant of a sponge holder, it does not perfectly match the typical **fenestrated jaws** of a Foerster sponge clamp. - An **Allis forcep** has rows of interlocking teeth at the tips, which are not visible on either instrument shown. *Needle holder and ovum forceps* - While one instrument is correctly identified as a needle holder, the other is not an **ovum forcep**. - **Ovum forceps** (or ovum clamps) have large, fenestrated, often curved jaws designed for grasping and removing placental tissue or polyps from the uterus.

Q: All are true about the lesion shown below except:

Severe itching. ***Severe itching*** - While keloids can cause **pruritus (itching)**, it is **variable** and not uniformly severe across all cases. - The intensity of itching in keloids varies significantly between patients, and it is **not as consistently present or severe** as the other defining features listed. - The primary **consistent symptoms** of keloids are **abnormal scarring beyond wound boundaries (claw-like extensions), firm raised appearance, and cosmetic concerns**, rather than severe pruritus being a universal hallmark. *Claw like process* - The image shows a **keloid**, which is characterized by its tendency to grow **beyond the boundaries of the original wound**, often forming **claw-like extensions**. - This **exuberant growth** into surrounding normal tissue is a **key differentiating feature** of keloids compared to hypertrophic scars, which remain within the original wound boundaries. *Develops at vaccination sites* - Keloids commonly develop at sites of **skin trauma**, including **vaccination sites**, piercings, acne, and surgical incisions. - The **deltoid region**, where many vaccinations are administered, is a frequent location for keloid formation, especially in **predisposed individuals** (more common in darker skin types and with genetic predisposition). *Collagen bundles are present* - Keloids are composed of **abnormally dense and disorganized collagen bundles** in the dermis, particularly **Type I and Type III collagen**. - Histologically, they show **thick, hyalinized collagen fibers** arranged in a haphazard fashion, extending into the subcutaneous fat, which distinguishes them from normal scars.

Question 1

All of the following carcinomas are associated with this condition shown in the image except:

Accepted Answer

Lung carcinoma

Answer

Gastric adenocarcinoma

Answer

Colorectal carcinoma

Answer

Ovarian carcinoma

Question 2

What is the functional capability of the instrument shown in the image?

Accepted Answer

Used for both cutting and coagulation

Answer

Used for coagulation

Answer

Used for cutting

Answer

Cannot be used in patient with artificial valves

Question 3

A 60-year-old male came with bleeding per rectum and was diagnosed to have carcinoma colon. The patient underwent extended hemicolectomy. Identify the instrument the surgeon is using: (AIIMS Nov 2016)

Accepted Answer

Harmonic scalpel

Answer

Ligasure vessel ligating system

Answer

Monopolar cautery

Answer

Hyfrecator

Question 4

What is the most likely diagnosis based on the image provided? The patient had a snake bite at this site 5 years ago.

Accepted Answer

Marjolin's ulcer

Answer

Bazin's ulcer

Answer

Martorell's ulcer

Answer

Meleney's ulcer

Question 5

A 60-year-old male patient with a history of weight gain and polyuria presents with the following lesion. What is the most possible diagnosis?

Accepted Answer

Diabetic ulcer

Answer

Buruli's ulcer

Answer

Venous ulcer

Answer

Meleney's ulcer

Question 6

What is shown in the image given below?

Accepted Answer

Lipoma

Answer

Radial artery aneurysm

Answer

Liposarcoma

Answer

Enchondroma

Question 7

All are correct about the image shown below except:

Accepted Answer

Grade 5 ulcer

Answer

Neuropathic ulcer

Answer

Hydrocolloid dressings

Answer

MRI to rule out osteomyelitis

Question 8

All are true about the lesion shown below except:

Accepted Answer

Severe itching

Answer

Claw like process

Answer

Develops at vaccination sites

Answer

Collagen bundles are present

Question 9

Identify these two surgical instruments.

Accepted Answer

Artery forceps and needle holder

Answer

Thumb forceps and sponge holder

Answer

Sponge holder and Allis forceps

Answer

Needle holder and ovum forceps

Question 10

All are true about the lesion shown below except:

Accepted Answer

Severe itching

Answer

Claw like process

Answer

Develops at vaccination sites

Answer

Collagen bundles are present

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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