General Surgery Principles Practice Questions

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 IIIB. ***Nyhus Type IIIB*** - The image shows a hernia occurring within **Hesselbach's triangle**, which is the anatomical site for a **direct inguinal hernia**. A direct inguinal hernia is classified as **Nyhus Type III**, as it involves a defect in the posterior wall of the inguinal canal, medial to the inferior epigastric vessels. - The "B" in Nyhus Type IIIB specifically denotes a **direct inguinal (III) hernia with a weakness in the posterior inguinal wall**. While the question asks for the specific Nyhus classification, options like Nyhus Type I, Type II, and Type IIIA, as well as a femoral hernia (Nyhus Type IV), are inconsistent with the highlighted location. *Nyhus Type I* - This classification refers to an **indirect inguinal hernia** where the internal ring is normal, typically seen in children. - It would originate lateral to the inferior epigastric artery, unlike the highlighted region. *Nyhus Type II* - This type describes an **indirect inguinal hernia** with an enlarged internal ring but an intact posterior inguinal wall. - This type of hernia would still originate lateral to the inferior epigastric vessels, not within Hesselbach's triangle. *Nyhus Type IIIA* - Nyhus Type IIIA specifically classifies an **indirect inguinal hernia** with an enlarged internal ring and a completely destructed transversalis fascia. - While it's also a Type III (indirect), Type IIIA refers to an indirect hernia, which emerges lateral to the inferior epigastric vessels, whereas a direct hernia (within Hesselbach's triangle) emerges medial to these vessels. *Nyhus Type IV* - This classification is for a **femoral hernia**, which occurs inferior to the inguinal ligament and through the femoral canal. - The highlighted area is clearly superior to the inguinal ligament and within the inguinal region, not the femoral region.

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.

Q: The following image shows:

Ommaya reservoir. ***Ommaya reservoir*** - The image displays an **Ommaya reservoir**, characterized by a **dome-shaped port** connected to a catheter. This device is typically implanted subcutaneously on the scalp and the catheter is placed into a cerebral ventricle. - It is used for repeated access to the **cerebrospinal fluid (CSF)**, primarily for administering chemotherapy directly into the CSF or for drawing CSF samples. *Chemo-port* - A chemo-port (also known as a port-a-cath) is a central venous access device, usually implanted under the skin in the chest, with the catheter tip residing in a large central vein. - While also used for chemotherapy, its structure differs, primarily being a **subcutaneous port** with a catheter ending in the venous system, not directly in brain ventricles like an Ommaya reservoir. *Peripherally inserted Central catheter* - A PICC line is a long, thin tube inserted into a peripheral vein (usually in the arm) and advanced until the tip reaches a large vein in the chest near the heart. - It is used for long-term intravenous access but is not designed for direct access to the cerebrospinal fluid. *Thermo-probe* - A thermo-probe is a device used to measure temperature, often in a medical context for monitoring body temperature during surgery or critical care. - Its design is entirely different, typically consisting of a sensor at the tip of a flexible wire, without the distinct reservoir and catheter structure seen in the image.

Q: A 25-year-old man with a history of road traffic injury presents to your clinic 4 months after the episode. His clinical presentation is shown in the image. What is the most likely diagnosis?

Normal scar. ***Normal scar*** - A **normal scar** appears as a flat, pale line, typically within the bounds of the original wound, as seen in the image after 4 months. - Histologically, a mature normal scar is characterized by **dense collagen bundles** arranged in parallel fashion, replacing the original dermis. *Keloid* - **Keloids** are characterized by **scar tissue growing beyond the boundaries of the original wound**, often appearing raised, firm, and reddish-purple. This is not seen in the image. - Histologically, keloids show irregularly arranged, **thick, hyalinized collagen bundles**, often with nodular formations and increased vascularity. *Hypertrophic scar* - A **hypertrophic scar** is elevated and red but remains **within the confines of the original wound**. Unlike keloids, they can often regress spontaneously. The image does not show an elevated or reddish scar. - Histologically, hypertrophic scars also feature **thick collagen bundles** but these are typically arranged **parallel to the epidermis** and are more organized than in keloids. *Wound contraction* - **Wound contraction** is a normal process during healing where the wound edges pull together, reducing the wound size. This is a process, not a final scar appearance. - While contraction occurs in all phases of wound healing, severe or excessive contraction can lead to **contractures**, which limit joint movement and are usually seen in extensive burns or chronic wounds.

Q: Which needle is shown below?

Vim-Silverman needle. ***Vim-Silverman needle*** - The image displays a needle with two prongs at the tip, which is characteristic of the **Vim-Silverman needle** used for **biopsy**. - This design allows for the capture of a tissue core between the prongs for microscopic examination. *Tru-cut needle* - A Tru-cut needle is also a biopsy needle, but it typically has a **single, cutting cannula** with a notch in its inner stylet. - Its design is different from the dual-pronged tip shown in the image. *Lumbar puncture needle* - A **lumbar puncture needle** (spinal needle) is used to access the subarachnoid space for cerebrospinal fluid (CSF) collection or drug administration. - It usually has a single, sharp bevel and a stylet, but lacks the biopsy collecting mechanism seen in the image. *Abraham's pleural biopsy needle* - **Abraham's pleural biopsy needle** is specifically designed for pleural biopsies and typically has a hook or a cutting edge that can be closed to obtain a tissue sample. - Its structure differs significantly from the bifurcated tip shown in the image.

Q: The commonest site of pressure sore is :

Sacrum. ***Sacrum*** - The **sacrum** is the most common site for pressure ulcers, accounting for approximately **40%** of all pressure sores, particularly in bedridden patients in supine position. - This area experiences **maximum pressure** when lying on the back due to body weight concentrating on the bony prominence against the mattress. *Ischium* - The **ischial tuberosities** are common pressure sore sites in **wheelchair-bound** patients or those spending extended periods sitting. - While frequently affected in seated patients, it is **less common overall** compared to the sacrum in general hospital populations. *Occiput* - The **occiput** (back of head) is vulnerable in **infants**, **critically ill patients**, or those unable to reposition their heads during prolonged supine positioning. - This site is **age-specific** and less frequent in the general adult population compared to sacral pressure sores. *Heel* - The **heel** is the **second most common** site for pressure ulcers, accounting for approximately **20%** of cases, especially in immobile or bedridden patients. - While frequently affected due to **bony prominence** and sustained pressure, it occurs **less often** than sacral pressure sores overall.

Q: Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - The **Limberg procedure** (rhomboid flap) and **Karydakis flap** are the most widely established plastic surgical techniques used to close the defect after pilonidal sinus excision. - These techniques aim to **flatten the natal cleft** and move the scar away from the midline, reducing tension and recurrence rates. - **Y-V plasty** is less commonly used specifically for pilonidal sinus compared to Limberg and Karydakis procedures, though it can be employed for tissue advancement in selected cases. - This combination excludes Z-plasty, which is not a primary technique for pilonidal sinus closure. *II, III and IV* - While **Karydakis procedure** is indeed a standard technique, this option incorrectly includes **Z-plasty**, which is generally used for **scar revision** or releasing contractures rather than primary closure of large excisional defects. - It also excludes the **Limberg flap**, which is one of the most commonly used techniques worldwide for pilonidal sinus surgery. *I, III and IV* - This option incorrectly includes **Z-plasty** while excluding **Y-V plasty**. - Z-plasty is not a primary technique for closing pilonidal sinus defects as it doesn't provide adequate tissue coverage for large excisions. - The **Limberg and Karydakis procedures** are the mainstay techniques from this list. *I, II and III* - This combination incorrectly includes **Z-plasty** as a primary technique for closing the excisional defect. - It omits the **Karydakis procedure**, which is one of the most widely recognized and effective flaps for pilonidal disease with excellent outcomes. - The Karydakis flap specifically focuses on **modifying the natal cleft contour** and displacing the incision laterally for better healing and lower recurrence rates.

Q: Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :

I, II and III. ***I, II and III*** - **I. Barbed sutures** have unidirectional or bidirectional barbs that grip tissue, negating the need for traditional knots to secure the suture line. This property can significantly **reduce operating time** and the volume of foreign material left in the wound. - **II. Vertical mattress sutures** are designed to achieve precise wound edge approximation and eversion, which are crucial for optimal healing and cosmesis, particularly in areas under tension or for thick skin. - **III. The Aberdeen knot** is a slip knot technique specifically designed to secure the end of a **continuous suture line** efficiently and reliably. It provides a flat, secure knot that minimizes bulk and is less prone to loosening. *I, II and IV* - While statements I and II are correct, statement IV is incorrect. **Silk is a braided, non-absorbable multifilament suture** that can cause significant tissue reaction. - It is generally not preferred for subcuticular suturing due to its increased risk of infection, visibility, and foreign body reaction compared to monofilament, absorbable sutures. *II, III and IV* - Statements II and III are correct, but statement IV is incorrect. **Silk is avoided for subcuticular closure** due to its inflammatory properties and potential for suture extrusion or sinus formation. - Subcuticular sutures typically use **absorbable monofilament sutures** (e.g., poliglecaprone 25 or polydioxanone) to minimize tissue reaction and achieve good cosmetic results. *I, III and IV* - Statements I and III are correct regarding barbed sutures and the Aberdeen knot, respectively. However, statement IV is incorrect because **silk suture is a non-absorbable, braided material that is highly reactive and not suitable for subcuticular placement**, where monofilament absorbable sutures are preferred for minimal tissue reaction and good cosmesis.

Q: Consider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?

I, III and IV. ***I, III and IV*** - **Diabetes** impairs wound healing through microvascular complications, neuropathy, and increased infection risk. - **Renal failure** (III) leads to uremia, malnutrition, and impaired collagen synthesis, all of which compromise wound integrity. - **Jaundice** (IV) is associated with impaired collagen synthesis, reduced fibroblast activity, and increased risk of infection, contributing to poor wound healing. *II, III and IV* - **Hypertension** (II) alone is not a direct risk factor for post-operative wound dehiscence; its complications (e.g., end-organ damage) might indirectly affect healing. - **Renal failure** (III) and **jaundice** (IV) are indeed significant risk factors, but the exclusion of diabetes makes this option incomplete. *I, II and III* - While **diabetes** (I) and **renal failure** (III) are major risk factors, **hypertension** (II) in isolation does not directly cause wound dehiscance. - This option incorrectly omits **jaundice** (IV), which is a known independent risk factor for impaired wound healing. *I, II and IV* - **Diabetes** (I) and **jaundice** (IV) are strong risk factors, but **hypertension** (II) does not directly contribute. - This option incorrectly excludes **renal failure** (III), which is a significant predisposing factor for wound dehiscence.

Question 1

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 IIIB

Answer

Nyhus Type I

Answer

Nyhus Type II

Answer

Nyhus Type IIIA

Question 2

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 3

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

Question 4

The following image shows:

Accepted Answer

Ommaya reservoir

Answer

Chemo-port

Answer

Peripherally inserted Central catheter

Answer

Thermo-probe

Question 5

A 25-year-old man with a history of road traffic injury presents to your clinic 4 months after the episode. His clinical presentation is shown in the image. What is the most likely diagnosis?

Accepted Answer

Normal scar

Answer

Keloid

Answer

Hypertrophic scar

Answer

Wound contraction

Question 6

Which needle is shown below?

Accepted Answer

Vim-Silverman needle

Answer

Tru-cut needle

Answer

Lumbar puncture needle

Answer

Abraham's pleural biopsy needle

Question 7

The commonest site of pressure sore is :

Accepted Answer

Sacrum

Answer

Heel

Answer

Ischium

Answer

Occiput

Question 8

Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound?
I. Limberg procedure
II. Y-V plasty
III. Z-plasty
IV. Karydakis procedure

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 9

Which of the following statements are correct regarding sutures in surgery?
I. Barbed sutures have the advantage of eliminating the need for knots.
II. Vertical mattress sutures help in eversion of wound edges.
III. Aberdeen knot is used for continuous suturing.
IV. Silk is preferred for subcuticular suturing.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 10

Consider the following :
I. Diabetes
II. Hypertension
III. Renal failure
IV. Jaundice

Which of the above are the risk factors for post-operative wound dehiscence?

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, II and IV

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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