General Surgery Principles Practice Questions

Q: The following suture material (polyglactin 910) gets absorbed in how many days?

56–70 days. **56–70 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 **56 to 70 days**. *7 days* - **Plain gut** sutures lose useful tensile strength very rapidly (within approximately 7 days), but complete absorption generally takes approximately **60–70 days**. - 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 catgut 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, monofilament 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. *Absorbed by hydrolysis* - Hydrolysis is the absorption mechanism for **synthetic absorbable sutures** (like Vicryl or PDS), not for catgut. - Catgut, being a natural absorbable suture, is broken down by phagocytosis and enzymatic degradation, not by hydrolysis.

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 (plain gut) 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 **plain gut absorbable suture**, which undergoes absorption through **tissue reaction** involving enzymatic breakdown and phagocytosis - This is the characteristic mechanism of absorption for **natural absorbable sutures** such as plain gut and chromic gut - The body's macrophages phagocytose suture particles while proteolytic enzymes break down the material components, allowing complete removal from tissues - Note: Synthetic absorbable sutures (e.g., Vicryl, Monocryl, PDS) are absorbed mainly by **hydrolysis** rather than enzymatic degradation and phagocytosis *Derived from cat intestinal tissue* - **Plain gut sutures** are not derived from cat intestinal tissue; they are derived from the **purified collagen of sheep or bovine intestinal submucosa** - The term "catgut" is a historical misnomer and does not refer to cats - Plain gut is therefore correctly described as an animal collagen-based suture, not a cat-derived product *Non-absorbable* - **Non-absorbable sutures** (silk, nylon, polypropylene) remain permanently in tissues or require removal - Plain gut is a natural absorbable suture absorbed by phagocytosis and enzymatic degradation, making this option incorrect for plain gut *Absorbed over 6 months* - **Plain gut** is typically completely absorbed within approximately **60–70 days**, far shorter than 6 months - Rapidly absorbing gut retains tensile strength for approximately **5–7 days** before losing mechanical integrity - An absorption period of 6 months is characteristic of longer-lasting synthetic sutures such as **PDS (180–210 days)**, not plain gut

Q: The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Nyhus Type IIIA. ***Nyhus Type IIIA*** - The image shows a hernia occurring within **Hesselbach's triangle**, which is the anatomical site for a **direct inguinal hernia**. Direct inguinal hernias are classified as **Nyhus Type IIIA** as they involve a defect in the **posterior wall** of the inguinal canal, medial to the **inferior epigastric vessels**. - Type IIIA specifically denotes a **direct inguinal hernia** with weakness or defect in the **transversalis fascia** of the posterior inguinal wall, which matches the highlighted location. *Nyhus Type I* - This classification refers to an **indirect inguinal hernia** in **pediatric patients** where the internal ring is normal sized. - It would originate **lateral** to the inferior epigastric vessels, not within **Hesselbach's triangle** as shown in the image. *Nyhus Type II* - This type describes an **indirect inguinal hernia** in **adults** with an enlarged internal ring but intact posterior inguinal wall. - Like Type I, this hernia would emerge **lateral** to the inferior epigastric vessels, not medial as demonstrated in the highlighted area. *Nyhus Type IIIB* - Type IIIB refers to a **large indirect inguinal hernia** with destruction of the posterior wall and extension into **Hesselbach's triangle**. - While it can involve Hesselbach's triangle, it primarily originates as an **indirect hernia** lateral to the inferior epigastric vessels, unlike the pure direct hernia shown in the image.

Q: The image shows a child with acute lymphoblastic leukemia. Identify the type of catheter shown:

Hickman catheter. ***Hickman catheter*** - The image clearly displays a **tunneled central venous catheter** with an external segment, consistent with a Hickman catheter. These catheters are used for long-term venous access, crucial for patients undergoing chemotherapy for conditions like acute lymphoblastic leukemia. - Hickman catheters are characterized by a **cuff** that promotes tissue ingrowth, anchoring the catheter and reducing infection risk, and having one or more lumens for infusions, blood draws, and medication administration. *Malecot catheter* - A Malecot catheter is a **self-retaining suprapubic catheter** typically used for bladder drainage, not for long-term venous access and multiple infusions. - Its design features winged tips that expand to hold it in place within an organ, which is distinct from the central venous access device shown. *Cimino-Brescia catheter* - A Cimino-Brescia fistula is an **arteriovenous fistula** created surgically for hemodialysis access, involving the direct connection of an artery and a vein. It is not an external catheter like the one pictured. - This option refers to a vascular access point rather than a catheter, and it's used for **dialysis**, not primarily for chemotherapy administration in the manner shown. *Peripherally inserted centrally catheter* - A peripherally inserted central catheter (PICC) is inserted into a peripheral vein (usually in the arm) and threaded into a central vein. While also a central venous catheter, it does not typically exit the chest wall as depicted. - Although it provides central venous access, the visual representation of the catheter exiting the chest through a subcutaneous tunnel indicates a **tunneled catheter**, not a PICC line typically inserted in the arm.

Q: A 60-year-old male presents to the emergency department on the second day of symptom onset with progressive deterioration of consciousness due to large right MCA territory infarct. Which of the following is the most appropriate management? (Image: img-179.jpeg)

Decompressive surgery. ***Decompressive surgery*** - A large **MCA territory infarct** causes significant brain edema, leading to increased **intracranial pressure** and progressive deterioration of consciousness, especially on day 2. - **Decompressive craniectomy** is often necessary in such cases to reduce pressure, prevent herniation, and improve outcomes by removing a portion of the skull. *Anticoagulation* - Anticoagulation is primarily used for preventing future thrombotic events due to conditions like **atrial fibrillation**, or for managing an evolving stroke if there's no major hemorrhage risk. - In the setting of a **large ischemic stroke** with significant edema and risk of hemorrhagic transformation, anticoagulation can increase the risk of bleeding into the infarct. *Dual antiplatelet therapy* - **Dual antiplatelet therapy** (DAPT) is typically used to prevent recurrent ischemic events following a **minor stroke** or **transient ischemic attack (TIA)**. - It is not indicated for managing acutely deteriorating consciousness due to brain edema in a **large established infarct**. *Mechanical thrombectomy* - **Mechanical thrombectomy** is an acute intervention performed within a narrow time window (typically up to 24 hours in select patients, but ideally much earlier) to remove the clot and **restore blood flow**. - On the second day of symptom onset, with a fully developed **large infarct** and progressive neurological deterioration due to edema, the brain tissue is likely already irreversibly damaged, making thrombectomy ineffective and potentially harmful due to reperfusion injury.

Question 1

The following suture material (polyglactin 910) gets absorbed in how many days?

Accepted Answer

56–70 days

Answer

7 days

Answer

21 days

Answer

Non-absorbable

Question 2

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 3

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 4

Identify the instrument shown in the image:

Accepted Answer

Asepto syringe

Answer

Trocar for tapping hydrocele

Answer

Czerny retractor

Answer

Malecot catheter

Question 5

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

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

Derived from cat gut mucosa

Answer

Absorbed by hydrolysis

Answer

It is less reactive

Question 6

Which retractor is shown in the image?

Accepted Answer

Deaver retractor

Answer

Morris retractor

Answer

Langenbeck retractor

Answer

Doyen retractor

Question 7

A surgical suture material (plain gut) 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

Non-absorbable

Answer

Absorbed over 6 months

Answer

Derived from cat intestinal tissue

Question 8

The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Accepted Answer

Nyhus Type IIIA

Answer

Nyhus Type I

Answer

Nyhus Type II

Answer

Nyhus Type IIIB

Question 9

The image shows a child with acute lymphoblastic leukemia. Identify the type of catheter shown:

Accepted Answer

Hickman catheter

Answer

Malecot catheter

Answer

Cimino-Brescia catheter

Answer

Peripherally inserted centrally catheter

Question 10

A 60-year-old male presents to the emergency department on the second day of symptom onset with progressive deterioration of consciousness due to large right MCA territory infarct. Which of the following is the most appropriate management? (Image: img-179.jpeg)

Accepted Answer

Decompressive surgery

Answer

Anticoagulation

Answer

Dual antiplatelet therapy

Answer

Mechanical thrombectomy

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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