General Surgery Principles Practice Questions

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.

Q: What type of suture is this?

Purse string suture. ***Purse string suture*** - The image shows a suture placed in a **circular pattern** around a wound opening, which can be **tightened like a drawstring** to close the defect. - This technique is characteristic of a **purse-string suture**, commonly used to close circular openings or to reduce the size of a defect for easier closure. *Pare's suture* - This is not a recognized or standard surgical suture technique. - Suture names are typically associated with their creators (e.g., Halsted) or their specific pattern/function (e.g., mattress, purse-string). *Halsted's suture* - Refers to a type of **interrupted mattress suture** or a principle of meticulous surgical technique, not a specific circular closing suture like the one pictured. - Halsted's sutures are typically used for strong wound closure and **eversion of wound edges**. *Vertical mattress interrupted suture* - This suture involves a "far-far, near-near" pattern, passing deep then superficial on each side of the wound, resulting in **strong closure** and **wound edge eversion**. - It consists of **individual, non-continuous stitches** (interrupted) and its appearance is distinct from the encircling pattern shown.

Q: Identify these two surgical instruments.

Artery forceps and needle holder. **Artery forceps and needle holder** - The instrument on the left is an **artery forceps (hemostat)**, characterized by its serrated jaws and a locking mechanism, designed for clamping vessels to control bleeding. - The instrument on the right is a **needle holder**, which has short, robust jaws with a cross-hatch pattern for secure gripping of surgical needles, and a ratcheted handle to lock the needle in place. *Thumb forceps and sponge holder* - **Thumb forceps** are non-locking instruments held like a pen, used for grasping tissue, and are not depicted here. - A **sponge holder** (also known as Foerster sponge forceps) typically has large, fenestrated jaws to hold surgical sponges, which is different from either of the instruments shown. *Sponge holder and Allis forceps* - As mentioned, a **sponge holder** is distinct and not shown in the image. - **Allis forceps** have multiple fine teeth that interlock to hold tissue firmly but atraumatically, which differs from the jaw patterns seen in these instruments. *Needle holder and ovum forceps* - While a **needle holder** is correctly identified on the right, the instrument on the left is not an **ovum forceps**. - **Ovum forceps** (or ovum polyp forceps) are used in gynecology, often having wide, fenestrated, cup-shaped jaws for grasping tissue during uterine procedures.

Q: The following suture material gets absorbed in how many days?

90 days. **90 days** - The image displays **Vicryl suture**, which is a **braided, absorbable suture** material made of polyglactin 910. - Vicryl typically retains tensile strength for about 2-3 weeks and is **completely absorbed** by hydrolysis in approximately **60 to 90 days**. *7 days* - Sutures that absorb in roughly 7 days, like **plain gut**, have a much **faster absorption profile** and are usually reserved for rapidly healing tissues. - Vicryl maintains its strength much longer and is used for tissues requiring more prolonged support, such as muscle repair. *21 days* - While Vicryl retains sufficient tensile strength for about **21 days (3 weeks)**, this refers to the period it provides adequate wound support, not its complete absorption time. - Complete absorption of Vicryl takes significantly longer than 21 days. *Non-absorbable* - **Non-absorbable sutures**, such as nylon or polypropylene, are designed to remain in the tissue permanently or until physically removed. - Vicryl's composition and mode of degradation (hydrolysis) clearly classify it as an **absorbable suture**.

Q: A woman presents 4 days after a laparotomy with complete wound dehiscence. After prescribing antibiotics the surgeon decides to suture the wound. Which of these suture materials should he use?

Ethilon. ***Ethilon*** * **Ethilon** (nylon) is a **non-absorbable monofilament suture** that is ideal for skin closure, especially in infected or contaminated wounds, because its smooth surface resists bacterial colonization. * Given the wound dehiscence and the potential for infection (antibiotics prescribed), a non-absorbable suture like Ethilon is preferred to provide strong, long-lasting support for surgical closures. *Mersilk* * **Mersilk** (braided silk) is a **non-absorbable multifilament suture** known for its excellent handling properties and knot security. * However, its **multifilament nature** can harbor bacteria in the setting of contaminated or infected wounds, making it less suitable than monofilament sutures for this scenario. *Vicryl* * **Vicryl** (polyglactin 910) is a **synthetic absorbable multifilament suture**. While strong initially, it loses tensile strength over several weeks. * In the context of a dehisced wound requiring long-term support and the potential for infection, an **absorbable suture** would not provide adequate prolonged wound closure strength. *Chromic catgut* * **Chromic catgut** is a **natural absorbable multifilament suture** that offers very short-term tensile strength, absorbed rapidly by the body. * It is generally **not recommended for skin closure**, especially in a reopened surgical wound, due to its rapid degradation and risk of promoting infection.

Q: The method of ulcer healing shown below generates a pressure of: (Recent NEET Pattern 2016-17)

Minus 125 mm Hg. ***Minus 125 mm Hg*** - The image depicts **Negative Pressure Wound Therapy (NPWT)**, also known as vacuum-assisted closure (VAC), which applies subatmospheric pressure to promote wound healing. - The standard therapeutic pressure for NPWT is **-125 mmHg**, which aids in wound contraction, granulation tissue formation, removal of exudate, and increased blood flow to the wound bed. - This pressure setting is well-established in clinical practice and supported by surgical literature. *Minus 100 cm of water* - While this represents negative pressure, **mmHg is the standard unit** used for measuring and reporting NPWT pressure settings, not cm H₂O. - Converting -100 cm H₂O to mmHg yields approximately -73.5 mmHg, which is lower than the commonly effective therapeutic pressure range for NPWT. *Plus 100 cm of water* - This indicates **positive pressure**, whereas NPWT fundamentally relies on **negative (subatmospheric) pressure** to achieve its therapeutic effects. - Positive pressure would not facilitate wound fluid removal, tissue contraction, or granulation tissue formation as intended by NPWT. *Plus 125 cm of water* - This represents **positive pressure**, which contradicts the core mechanism of action of **Negative Pressure Wound Therapy**. - Positive pressure would push against the wound rather than creating the suction needed to draw out exudate and promote wound closure.

Q: Identify the instrument shown in the image:

Asepto syringe. ***Asepto syringe*** - The image displays a **red rubber bulb** attached to a glass or plastic barrel ending in a nozzle, which is characteristic of an **Asepto syringe**. - Asepto syringes are commonly used for **irrigation** of wounds or surgical sites, and for various procedures where precise suction or fluid delivery is needed without a needle. *Trocar for tapping hydrocele* - A **trocar** is a pointed medical instrument with a sharp tip, typically used with a cannula to introduce instruments or drain fluids from a body cavity. - Trocars for hydrocele tapping would differ significantly in appearance, featuring a pointed tip and often a stylet, which are absent here. *Czerny retractor* - A **Czerny retractor** is a surgical instrument with two blades, used primarily to hold back tissue during surgery to provide a clear view of the surgical field. - The instrument shown here is focused on fluid suction/delivery, not on tissue retraction. *Malecot catheter* - A **Malecot catheter** is a type of self-retaining catheter, typically made from soft, flexible material, with a distinctive mushroom-shaped tip that helps anchor it within a viscus. - This image clearly depicts a syringe-like device with a bulb, not a flexible catheter with a four-winged tip.

Q: Which is correct about the suture material shown in the image?

Absorbed by phagocytosis and enzymatic degradation. ***Absorbed by phagocytosis and enzymatic degradation*** - This description is characteristic of **natural absorbable sutures**, such as **catgut** (which appears to be depicted by the golden, multi-filament material with a needle). Catgut is absorbed by the body's enzymatic processes and macrophage activity. - This type of absorption is a key feature distinguishing natural absorbable sutures from synthetic ones (which are absorbed by hydrolysis) and non-absorbable sutures. *It is less reactive* - Natural absorbable sutures like catgut are generally associated with a **higher inflammatory reaction** in tissues compared to synthetic absorbable sutures due to their proteinacious nature. - The body's immune system recognizes these natural proteins, leading to a more pronounced foreign body response. *Derived from cat gut mucosa* - **Catgut sutures** are indeed derived from the sub-mucosal layer of the sheep or goat **intestine**, not the mucosa itself. - The term "catgut" is historical and misleading, as it is not derived from cats. *Used for bowel anastomosis* - While absorbable sutures are used for bowel anastomosis, the use of **plain catgut** (which the image suggests due to its color and appearance) is generally not preferred for critical anastomoses due to its variable and rapid absorption time, which can compromise wound strength before healing is complete. - **Chromic catgut** or synthetic absorbable sutures (like Vicryl or PDS) with more predictable absorption profiles are typically favored for bowel anastomoses.

Q: Which retractor is shown in the image?

Deaver retractor. ***Deaver retractor*** - The Deaver retractor is easily identifiable by its distinct **flat, C-shaped, curved blade** at one end and a **long handle with a fenestrated grip**. - It is commonly used in deep abdominal and thoracic procedures to **retract organs and tissues**, providing excellent exposure. *Morris retractor* - The Morris retractor typically features a **curved blade** that is less pronounced than a Deaver and often includes a **fenestrated handle**. - However, its blade is generally **flatter and broader** compared to the distinctive C-shape of the Deaver. *Langenbeck retractor* - A Langenbeck retractor is characterized by a **small, L-shaped blade** and a handle, designed for retracting small incisions and delicate tissues. - Its blade is significantly smaller and has a **sharper, angled bend** compared to the broad, C-shaped blade shown. *Doyen retractor* - The Doyen retractor, also known as a Doyen rib raspatory, is typically used to **retract ribs** and protect lung tissue during thoracic surgeries. - It has a distinctive **hooked end** or a spoon-like blade, which is quite different from the broad, curved blade in the image.

Q: A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Absorbed by phagocytosis and enzymatic degradation. ***Absorbed by phagocytosis and enzymatic degradation*** - The image shows a **braided absorbable suture**, which undergoes absorption through **tissue reaction** involving enzymatic breakdown and phagocytosis - This is the characteristic mechanism of absorption for most **absorbable sutures** (both natural like catgut and synthetic like Vicryl, Monocryl, PDS) - The body's macrophages phagocytose suture particles while proteolytic enzymes break down the material components, allowing complete removal from tissues *Derived from catgut* - While **catgut sutures** (derived from sheep/bovine intestinal submucosa) are absorbable, modern synthetic absorbable sutures like **polyglactin (Vicryl)** or **polyglycolic acid (Dexon)** are more commonly used - The image appearance and braided structure suggest a synthetic absorbable suture rather than catgut - Catgut is less commonly used today due to higher tissue reactivity and unpredictable absorption *Non-absorbable* - **Non-absorbable sutures** (silk, nylon, polypropylene) remain permanently in tissues or require removal - The mechanism of absorption by phagocytosis and enzymatic degradation specifically defines **absorbable sutures**, making this option incorrect - Non-absorbable sutures maintain tensile strength indefinitely *Absorbed over 3 months* - Absorption time varies significantly by suture type: **rapidly absorbing gut (5-7 days)**, **Vicryl (56-70 days)**, **PDS (180-210 days)** - While some sutures absorb around 90 days, this is not a universal characteristic - The statement is too specific and not applicable to all absorbable sutures shown

Question 1

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 2

What type of suture is this?

Accepted Answer

Purse string suture

Answer

Pare's suture

Answer

Halsted's suture

Answer

Vertical mattress interrupted suture

Question 3

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 4

The following suture material gets absorbed in how many days?

Accepted Answer

90 days

Answer

7 days

Answer

21 days

Answer

Non-absorbable

Question 5

A woman presents 4 days after a laparotomy with complete wound dehiscence. After prescribing antibiotics the surgeon decides to suture the wound. Which of these suture materials should he use?

Accepted Answer

Ethilon

Answer

Vicryl

Answer

Chromic catgut

Answer

Mersilk

Question 6

The method of ulcer healing shown below generates a pressure of: (Recent NEET Pattern 2016-17)

Accepted Answer

Minus 125 mm Hg

Answer

Minus 100 cm of water

Answer

Plus 100 cm of water

Answer

Plus 125 cm of water

Question 7

Identify the instrument shown in the image:

Accepted Answer

Asepto syringe

Answer

Trocar for tapping hydrocele

Answer

Czerny retractor

Answer

Malecot catheter

Question 8

Which is correct about the suture material shown in the image?

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

It is less reactive

Answer

Derived from cat gut mucosa

Answer

Used for bowel anastomosis

Question 9

Which retractor is shown in the image?

Accepted Answer

Deaver retractor

Answer

Morris retractor

Answer

Langenbeck retractor

Answer

Doyen retractor

Question 10

A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

Derived from catgut

Answer

Non-absorbable

Answer

Absorbed over 3 months

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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