General Surgery Principles Practice Questions

Q: Which of the following is NOT required for wound healing?

None of the above. ### Explanation The correct answer is **None of the above** because Zinc, Copper, and Vitamin C are all essential micronutrients required for the complex process of wound healing. A deficiency in any of these can lead to delayed healing or wound dehiscence. **Why the options are essential:** * **Zinc (Option A):** Zinc is a critical cofactor for **DNA polymerase and RNA polymerase**, making it essential for cell proliferation during the epithelialization phase. It also plays a vital role in **matrix metalloproteinases (MMPs)**, which are necessary for wound remodeling. * **Copper (Option B):** Copper is a cofactor for the enzyme **lysyl oxidase**. This enzyme is responsible for the cross-linking of collagen and elastin fibers, which provides the wound with its ultimate tensile strength. * **Vitamin C (Option C):** Also known as Ascorbic acid, it is required for the **hydroxylation of proline and lysine** residues during collagen synthesis. Without Vitamin C, stable collagen triple helices cannot form, leading to impaired wound healing (as seen in Scurvy). **Clinical Pearls for NEET-PG:** * **Tensile Strength:** A wound reaches approximately 3% of its final strength at 1 week, 20% at 3 weeks, and plateaus at **70-80%** by 3 months. It never regains 100% of the original tissue strength. * **Collagen Types:** Type III collagen is synthesized first (granulation tissue), which is later replaced by the stronger **Type I collagen** during the remodeling phase. * **Most Common Cause of Delayed Healing:** Local **infection** is the most common cause of wound healing failure, while **malnutrition** (protein-energy malnutrition) is a significant systemic cause. * **Steroids:** These inhibit wound healing by decreasing inflammation and collagen synthesis. Interestingly, **Vitamin A** can help reverse the inhibitory effects of steroids on wound healing.

Q: Which of the following is a complication of mastectomy?

All of the above. **Explanation:** Mastectomy is a major surgical procedure associated with several early and late complications. The correct answer is **All of the above** because each option represents a recognized clinical outcome following the procedure. 1. **Seroma (Option A):** This is the **most common** early complication of mastectomy. It involves a collection of serous fluid in the dead space under the skin flaps or in the axilla. It occurs due to the disruption of lymphatics and capillaries during dissection. 2. **Long Thoracic Nerve Palsy (Option B):** During axillary lymph node dissection (ALND), the long thoracic nerve (Nerve of Bell) is at risk. Injury leads to paralysis of the **Serratus Anterior** muscle, clinically presenting as **"Winging of the Scapula."** 3. **Angiosarcoma (Option C):** This is a rare but dreaded late complication known as **Stewart-Treves Syndrome**. It refers to lymphangiosarcoma arising in a limb affected by chronic lymphedema (usually 10+ years post-mastectomy). **Clinical Pearls for NEET-PG:** * **Nerve Injuries:** * *Intercostobrachial nerve:* Most commonly injured nerve; leads to numbness of the inner aspect of the upper arm. * *Thoracodorsal nerve:* Injury leads to weakness in internal rotation and adduction (Latissimus dorsi). * **Lymphedema:** Occurs in about 10-25% of patients post-ALND; risk is significantly reduced with Sentinel Lymph Node Biopsy (SLNB). * **Flap Necrosis:** Usually occurs at the edges of the skin flaps if they are tensioned or too thin.

Q: Which of the following types of shock is characterized by low peripheral resistance?

Distributive. **Explanation:** Shock is defined as a state of cellular hypoxia due to an imbalance between oxygen supply and demand. The hemodynamic profile of shock is determined by the relationship: **MAP = CO × SVR** (Mean Arterial Pressure = Cardiac Output × Systemic Vascular Resistance). **Why Distributive Shock is Correct:** In **Distributive shock** (e.g., Septic, Anaphylactic, or Neurogenic shock), the primary pathology is massive peripheral vasodilation. This results in a significant **decrease in Systemic Vascular Resistance (SVR)** or peripheral resistance. To compensate, the heart typically increases cardiac output (except in neurogenic shock), leading to the classic clinical presentation of "warm shock." **Why Other Options are Incorrect:** * **Hypovolemic Shock:** Caused by loss of blood or fluid. The body compensates via the sympathetic nervous system, causing vasoconstriction to maintain BP. Thus, **SVR is increased**. * **Cardiogenic Shock:** Caused by pump failure (e.g., MI). Low cardiac output triggers a compensatory increase in peripheral resistance to maintain perfusion to vital organs. Thus, **SVR is increased**. * **Obstructive Shock:** Caused by physical obstruction to blood flow (e.g., Tension pneumothorax, Cardiac tamponade). Similar to cardiogenic shock, the body responds with compensatory vasoconstriction. Thus, **SVR is increased**. **High-Yield NEET-PG Pearls:** * **SVR** is the hallmark differentiator: It is **decreased** only in Distributive shock and **increased** in Hypovolemic, Cardiogenic, and Obstructive shock. * **Septic Shock** is the most common subtype of distributive shock. * **Neurogenic Shock** is unique because it presents with **bradycardia** (due to loss of sympathetic tone), whereas all other forms of shock typically present with tachycardia. * **PCWP (Pulmonary Capillary Wedge Pressure)** is elevated in Cardiogenic shock but decreased in Hypovolemic shock.

Q: What is true of Spigelian hernia?

It occurs at the lateral edge of the linea semilunaris.. ### Explanation **Correct Answer: D. It occurs at the lateral edge of the linea semilunaris.** A **Spigelian hernia** (also known as a spontaneous interstitial ventral hernia) occurs through the **Spigelian fascia**. This fascia is the layer of the rectus sheath found between the **linea semilunaris** (the lateral border of the rectus abdominis muscle) and the lateral edge of the abdominal muscles. Most of these hernias occur at or below the **arcuate line** (the "Spigelian hernia belt"), where the posterior rectus sheath is deficient, making it a point of anatomical weakness. #### Analysis of Incorrect Options: * **Option A:** Spigelian hernias are not exclusive to males; they occur in both sexes, often appearing in the 5th to 6th decades of life. * **Option B:** This describes a **Richter’s hernia**, where only a portion of the bowel circumference is trapped. While a Spigelian hernia *could* contain a Richter’s-type strangulation, it is not a defining characteristic. * **Option C:** The **Bassini technique** is specifically for **inguinal hernias**. Spigelian hernias are repaired via a transverse incision over the mass or laparoscopically (IPOM or TEP), usually involving mesh reinforcement. #### High-Yield Clinical Pearls for NEET-PG: * **Location:** Most common at the level of the **arcuate line** (Spigelian hernia belt). * **Clinical Presentation:** Often difficult to diagnose because the hernia sac is **interstitial** (lies deep to the external oblique aponeurosis), meaning a palpable bulge may be absent. * **Diagnosis:** **Ultrasound or CT scan** is the investigation of choice due to the vague clinical presentation. * **Risk:** They have a **high risk of strangulation** because of the narrow, rigid neck of the defect.

Q: All of the following statements regarding medullary carcinoma of the thyroid are true EXCEPT:

It is dependent on TSH.. **Explanation:** Medullary Carcinoma of the Thyroid (MTC) is a unique neuroendocrine tumor that differs significantly from differentiated thyroid cancers (Papillary and Follicular). **1. Why Option C is correct (The False Statement):** Unlike Papillary and Follicular carcinomas, which arise from follicular cells and are regulated by Thyroid Stimulating Hormone (TSH), MTC arises from **parafollicular 'C' cells**. These cells are of neural crest origin and do not possess TSH receptors. Therefore, MTC is **not dependent on TSH**, and TSH suppression therapy has no role in its management. **2. Analysis of other options:** * **Option A:** MTC arises from 'C' cells, which are responsible for secreting **Calcitonin**. This serves as a vital tumor marker for diagnosis and post-operative follow-up. * **Option B:** MTC is aggressive. It spreads via **lymphatics** to cervical lymph nodes (early) and via the **bloodstream (hematogenous)** to the liver, lungs, and bones. * **Option D:** Approximately **75-80% of cases are sporadic**. The remaining 20-25% are familial, associated with **MEN 2A, MEN 2B**, or Familial MTC (FMTC) syndromes. **Clinical Pearls for NEET-PG:** * **Genetics:** Familial cases are associated with the **RET proto-oncogene** mutation. Prophylactic thyroidectomy is recommended for carriers. * **Histology:** Characterized by deposits of **Amyloid** (transcribed from calcitonin) which stains with **Congo Red** (apple-green birefringence). * **Surgery:** The treatment of choice is **Total Thyroidectomy with Central Compartment Neck Dissection**, as MTC does not take up radioiodine.

Q: Dermoid cysts are most commonly seen in which of the following locations?

Skull. **Explanation:** The correct answer is **Skull**. Dermoid cysts are developmental sequestration cysts that occur during embryonic development when surface ectoderm becomes trapped along the lines of embryonic fusion. **1. Why Skull is Correct:** The most common site for a sequestration dermoid is the **lateral angle of the orbit** (external angular dermoid), where the frontonasal and maxillary processes fuse. Other frequent sites include the midline of the nose, the scalp, and the post-auricular region. These cysts are often fixed to the underlying periosteum and may cause a "pressure erosion" or "pitting" of the outer table of the skull, which is a classic radiological finding. **2. Why Other Options are Incorrect:** * **Finger:** Cysts found here are typically **Implantation Dermoids** (Acquired), caused by trauma driving surface epithelium into deeper tissues. While common in manual laborers, they are not the "most common" site for dermoids in general compared to developmental sites. * **Skin:** While dermoids are subcutaneous, "skin" is too vague. Most skin-related lumps are sebaceous cysts (retention cysts), which are distinct from developmental dermoids. * **Hip:** This is an extremely rare site for dermoid cysts. **Clinical Pearls for NEET-PG:** * **Clinical Feature:** Dermoids are non-tender, fluctuate, and are **not** attached to the overlying skin (unlike sebaceous cysts), but are often attached to the underlying bone. * **Test:** They do not transilluminate (unlike cystic hygromas). * **Warning:** Midline dermoids on the skull (especially the bridge of the nose) may have an intracranial extension; always rule this out with imaging (CT/MRI) before excision to avoid a CSF leak.

Q: What defines a Spigelian hernia?

Hernia occurring at the level of the arcuate line. ### Explanation **Spigelian Hernia** (also known as a lateral ventral hernia) occurs through the **Spigelian aponeurosis**. This is the layer of fascia between the lateral border of the rectus abdominis muscle and the semilunar line (the transition from the transversus abdominis muscle to its aponeurosis). **Why Option D is Correct:** The hernia most commonly occurs at or below the **arcuate line (of Douglas)**. At this level, the posterior rectus sheath is absent, and the aponeurosis is at its weakest. The defect typically lies between the layers of the abdominal wall (interparietal), meaning the hernia sac often remains hidden beneath the external oblique aponeurosis, making it difficult to diagnose clinically. **Analysis of Incorrect Options:** * **Option A (Obturator canal):** Defines an **Obturator hernia**, which passes through the obturator foramen. It is classic in elderly, thin females (Howship-Romberg sign). * **Option B (Linea alba):** Defines an **Epigastric hernia**, occurring through the midline fibers between the xiphoid process and the umbilicus. * **Option C (Triangle of Petit):** Defines an **Inferior Lumbar hernia**. The Petit triangle is bounded by the iliac crest, latissimus dorsi, and external oblique. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Usually found at the "Spigelian Hernia Belt"—a transverse zone 0–6 cm cranial to the interspinal line. * **Diagnosis:** Often presents as a non-specific abdominal bulge or pain. **Ultrasound or CT** is the gold standard for diagnosis due to its interparietal nature. * **Management:** High risk of strangulation (due to narrow neck); therefore, surgical repair (open or laparoscopic) is always recommended.

Question 1

Which of the following produces the least damage to blood elements?

Accepted Answer

Membrane oxygenator

Answer

Disc oxygenator

Answer

Bubble oxygenator

Answer

Screen oxygenator

Question 2

Which of the following is NOT required for wound healing?

Accepted Answer

None of the above

Answer

Zinc

Answer

Copper

Answer

Vitamin C

Question 3

Which of the following is a complication of mastectomy?

Accepted Answer

All of the above

Answer

Seroma

Answer

Long thoracic nerve palsy

Answer

Angiosarcoma

Question 4

Intraoral vertical ramus osteotomy is done for which of the following conditions?

Accepted Answer

Mandibular setback

Answer

Anterior open bite

Answer

Mandibular advancement

Answer

Maxillary deformity

Question 5

Which of the following types of shock is characterized by low peripheral resistance?

Accepted Answer

Distributive

Answer

Hypovolemic

Answer

Cardiogenic

Answer

Obstructive

Question 6

What is true of Spigelian hernia?

Accepted Answer

It occurs at the lateral edge of the linea semilunaris.

Answer

It occurs exclusively in males.

Answer

It involves part of the circumference of the bowel wall.

Answer

It is best repaired by the classical Bassini technique of inguinal ligament repair.

Question 7

All of the following statements regarding medullary carcinoma of the thyroid are true EXCEPT:

Accepted Answer

It is dependent on TSH.

Answer

It arises from 'C' cells.

Answer

Both hematogenous and lymphatic spread are seen.

Answer

Most cases are sporadic.

Question 8

Dermoid cysts are most commonly seen in which of the following locations?

Accepted Answer

Skull

Answer

Finger

Answer

Skin

Answer

Hip

Question 9

Thyroid storm after total thyroidectomy is most commonly due to which of the following factors?

Accepted Answer

Inadequate preoperative preparation

Answer

Damage to the recurrent laryngeal nerve

Answer

Rough handling of thyroid tissue during surgery

Answer

Removal of parathyroid glands

Question 10

What defines a Spigelian hernia?

Accepted Answer

Hernia occurring at the level of the arcuate line

Answer

Hernia passing through the obturator canal

Answer

Hernia occurring through the linea alba

Answer

Hernia through the triangle of Petit

General Surgery Principles — MCQs

General Surgery Principles — MCQs

On this page

Practice by Chapter

Want unlimited practice?