General Surgery Principles — MCQs
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Negative pressure dressing is used for which of the following indications?
Hydatid cyst occurs most commonly in which organ?
The provided image is a thyroid scan. Based on the scan, what is the most probable diagnosis?
What is a keloid scar?
Reactionary hemorrhage occurs after extraction because of which of the following?
A Grade III wound is considered contaminated if it is:
Which of the following statements about Pilonidal sinus is true?
All of the following are true about hernia surgery except:
In diabetic foot, which type of amputation is contraindicated?
What is the most common complication following hemorrhoidectomy?
General Surgery Principles Indian Medical PG Practice Questions and MCQs
Question 461: Negative pressure dressing is used for which of the following indications?
- A. Removal of eschar
- B. Chronic non-healing diabetic ulcer (Correct Answer)
- C. Unexplored fistulas
- D. Untreated osteomyelitis
Explanation: **Explanation:** **Negative Pressure Wound Therapy (NPWT)**, also known as Vacuum-Assisted Closure (VAC), is a gold-standard modality for managing complex wounds. **Why Option B is Correct:** NPWT is highly effective for **chronic non-healing diabetic ulcers** because it works through several mechanisms: * **Macro-strain:** Draws wound edges together, facilitating primary closure. * **Micro-strain:** Creates mechanical tension at the cellular level, stimulating angiogenesis and the formation of healthy **granulation tissue**. * **Exudate Management:** Continuously removes excess interstitial fluid and bacteria, reducing localized edema and improving capillary blood flow. **Why Other Options are Incorrect:** * **A. Removal of eschar:** NPWT is not a debridement tool. Wounds must be surgically debrided of all necrotic tissue and eschar before application; otherwise, the vacuum cannot reach the viable tissue. * **C. Unexplored fistulas:** NPWT is contraindicated in unexplored or non-enteric fistulas because the suction can worsen the tract or cause organ damage. * **D. Untreated osteomyelitis:** NPWT should not be applied over active, untreated bone infections as it may trap the infection and lead to sepsis. The infection must be treated with antibiotics and debridement first. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Malignancy in the wound, untreated osteomyelitis, exposed vital organs/vessels, and necrotic tissue with eschar. * **Pressure Settings:** Usually maintained between **-75 mmHg to -125 mmHg** (continuous or intermittent). * **Key Benefit:** It significantly reduces the frequency of dressing changes and prepares the wound bed for subsequent skin grafting or flaps.
Question 462: Hydatid cyst occurs most commonly in which organ?
- A. Lung
- B. Liver (Correct Answer)
- C. Spleen
- D. Brain
Explanation: **Explanation:** Hydatid disease is a parasitic infection caused by the larval stage of **Echinococcus granulosus**. The life cycle involves dogs as definitive hosts and sheep/cattle as intermediate hosts. Humans are accidental intermediate hosts. **Why Liver is the correct answer:** The primary route of infection is the ingestion of eggs (oncospheres) via contaminated food or water. Once ingested, the eggs hatch in the duodenum, and the larvae penetrate the intestinal mucosa to enter the **portal venous system**. Since the liver acts as the first major filter for portal blood, it is the most common site of involvement, accounting for approximately **70-75%** of cases. The right lobe is more frequently affected than the left. **Why other options are incorrect:** * **Lung (Option A):** This is the second most common site (15-25%). Larvae reach the lungs if they bypass the hepatic filter and enter the systemic circulation via the hepatic veins and inferior vena cava. In children, the lungs are relatively more common than in adults. * **Spleen (Option C):** Splenic involvement is rare (2-3%) and usually occurs via systemic dissemination or direct spread. * **Brain (Option D):** Cerebral hydatidosis is very rare (<1%) and typically presents with signs of increased intracranial pressure. **High-Yield Clinical Pearls for NEET-PG:** * **Pathognomonic Sign:** "Water lily sign" (detached endocyst membrane) on imaging. * **Serology:** ELISA is the screening test of choice; Casoni’s test is now obsolete. * **Treatment:** **PAIR** (Puncture, Aspiration, Injection of scolicidal agent, Re-aspiration) is used for specific WHO stages. * **Scolicidal agents:** Hypertonic saline (most common) or Cetrimide. **Formalin is no longer used** due to the risk of sclerosing cholangitis. * **Medical Management:** Albendazole is the drug of choice, often started pre-operatively to reduce cyst tension and prevent anaphylaxis from spillage.
Question 463: The provided image is a thyroid scan. Based on the scan, what is the most probable diagnosis?
- A. Papillary carcinoma of the thyroid
- B. Lateral aberrant thyroid
- C. Hypersecreting adenoma (Correct Answer)
- D. Graves disease
Explanation: ***Hypersecreting adenoma*** - Shows a **hot nodule** with increased uptake and **suppression of the remaining thyroid gland**, characteristic of a **toxic adenoma**. - The autonomous hyperfunctioning nodule produces excess thyroid hormone, causing feedback inhibition of **TSH** and suppression of normal thyroid tissue. *Papillary carcinoma of the thyroid* - Typically appears as a **cold nodule** with decreased or absent uptake on thyroid scan due to loss of iodine-concentrating ability. - Most thyroid malignancies are **non-functional** and do not suppress normal thyroid tissue. *Lateral aberrant thyroid* - Represents **ectopic thyroid tissue** located laterally in the neck, often appearing as uptake outside the normal thyroid location. - Would show uptake in an **abnormal anatomical position**, not within the thyroid gland itself. *Graves disease* - Characterized by **diffuse increased uptake** throughout the entire thyroid gland on scintigraphy. - Shows **uniform hyperactivity** of the whole gland rather than a single hyperfunctioning nodule with suppressed surrounding tissue.
Question 464: What is a keloid scar?
- A. Excessive scar tissue that does not extend beyond the boundary of the original incision or wound.
- B. Excessive scar tissue that extends beyond the boundaries of the original incision or wound. (Correct Answer)
- C. Pale, flat, and stretched in appearance, often appearing on the back and in areas of tension.
- D. Pale, flat, and stretched in appearance, often appearing on the chest and sternum and in areas of no tension.
Explanation: ### Explanation **1. Understanding the Correct Answer (Option B)** A **keloid** is a pathological scar resulting from an abnormal proliferation of fibrous tissue (specifically Type I and III collagen) following skin injury. The defining characteristic of a keloid is that it **extends beyond the boundaries of the original wound**, invading surrounding healthy skin. This occurs due to an imbalance between collagen synthesis and degradation, often persisting for years without spontaneous regression. **2. Analysis of Incorrect Options** * **Option A:** This describes a **Hypertrophic Scar**. While both involve excessive collagen, a hypertrophic scar remains confined to the original wound margins and often regresses over time. * **Option C & D:** These describe **Atrophic or Stretched Scars**. These occur when the repair process is insufficient or when a scar is subjected to constant tension (common on the back), leading to a thin, flat, and pale appearance rather than the raised, firm nature of a keloid. **3. NEET-PG High-Yield Clinical Pearls** * **Common Sites:** Pre-sternal area, deltoid, and earlobes (rarely occurs on palms or soles). * **Histology:** Characterized by thick, disorganized, "glassy" **collagen bundles** (Keloid collagen). * **Risk Factors:** More common in dark-skinned individuals (African/Asian descent) and associated with blood group A. * **Treatment:** Intralesional **Triamcinolone** (corticosteroid) is the first-line treatment. Surgical excision alone has a high recurrence rate (up to 80%) and should be combined with adjuvant therapy like radiotherapy or pressure garments.
Question 465: Reactionary hemorrhage occurs after extraction because of which of the following?
- A. Broken roots
- B. High blood pressure (Correct Answer)
- C. Sharp interdental septum
- D. Gingival laceration
Explanation: **Explanation:** **Reactionary hemorrhage** is defined as bleeding that occurs within **24 hours** (usually 4–6 hours) following a surgical procedure or trauma. The underlying pathophysiology involves the **recovery of blood pressure** to normal or high levels as the effects of anesthesia (which often contains vasoconstrictors like adrenaline) wear off. During surgery, hypotension or local vasoconstriction may prevent bleeding from small vessels. As the patient’s blood pressure rises post-operatively or the vasoconstrictor effect diminishes, these small vessels dilate, or "clots are blown off," leading to reactionary hemorrhage. Therefore, **High blood pressure** is a primary systemic factor that triggers this event. **Analysis of Incorrect Options:** * **A. Broken roots:** While a retained root tip can cause delayed healing or infection, it is not a primary cause of acute reactionary hemorrhage. * **C. Sharp interdental septum:** This may cause irritation or localized pain but does not typically cause significant post-operative bleeding. * **D. Gingival laceration:** This would typically cause **Primary hemorrhage** (bleeding occurring at the time of surgery) rather than reactionary hemorrhage. **High-Yield NEET-PG Pearls:** 1. **Primary Hemorrhage:** Occurs at the time of surgery (due to vessel injury). 2. **Reactionary Hemorrhage:** Occurs within 24 hours (due to rise in BP/slippage of ligatures). 3. **Secondary Hemorrhage:** Occurs 7–14 days post-surgery (classically due to **infection** eroding a vessel wall). 4. **Management:** For reactionary hemorrhage in dental extraction, initial management includes local pressure, suturing, or hemostatic agents (like Gelfoam); systemic hypertension must be controlled.
Question 466: A Grade III wound is considered contaminated if it is:
- A. An appendicular perforation
- B. A wound contaminated with gross fecal material spillage (Correct Answer)
- C. A wound in the urinary tract without unusual contamination
- D. A surgical site with no unusual contamination
Explanation: ### Explanation The classification of surgical wounds is a high-yield topic for NEET-PG, based on the **CDC Surgical Wound Classification** system. This system predicts the risk of postoperative surgical site infections (SSI). **1. Why the Correct Answer is Right:** A **Grade III (Contaminated) wound** is defined by the presence of gross spillage from the gastrointestinal tract, acute non-purulent inflammation, or major breaks in sterile technique. **Gross fecal material spillage** represents a significant bacterial load introduced into a previously sterile or controlled environment, placing it squarely in the "Contaminated" category. **2. Analysis of Incorrect Options:** * **Option A (Appendicular perforation):** This is classified as **Grade IV (Dirty/Infected)**. Any wound involving perforated viscera, pus, or clinical infection present before the operation is considered "Dirty." * **Option C (Urinary tract without unusual contamination):** This is a **Grade II (Clean-Contaminated)** wound. These are elective procedures where the respiratory, alimentary, or genitourinary tracts are entered under controlled conditions without unusual contamination. * **Option D (Surgical site with no unusual contamination):** This describes a **Grade I (Clean)** wound. These are uninfected operative wounds where no inflammation is encountered and the respiratory, alimentary, or genitourinary tracts are *not* entered. **3. Clinical Pearls for NEET-PG:** * **Grade I (Clean):** SSI risk <2%. Example: Hernioplasty, Thyroidectomy. * **Grade II (Clean-Contaminated):** SSI risk <10%. Example: Elective Cholecystectomy. * **Grade III (Contaminated):** SSI risk 15–20%. Example: Penetrating trauma <4 hours old, gross bile spillage. * **Grade IV (Dirty):** SSI risk up to 40%. Example: Peritonitis, Faecal fistula, traumatic wounds >4 hours old. * **Key Distinction:** Spillage = Contaminated (III); Perforation/Pus = Dirty (IV).
Question 467: Which of the following statements about Pilonidal sinus is true?
- A. More common in females
- B. Mostly congenital
- C. Prognosis after surgery is poor
- D. Treatment of choice is surgical excision of the sinus tract (Correct Answer)
Explanation: **Explanation:** Pilonidal sinus is a chronic inflammatory condition occurring primarily in the sacrococcygeal region. The correct answer is **D** because the definitive management of a symptomatic pilonidal sinus involves the complete surgical removal of the sinus tract and its associated hair nests to prevent recurrence. **Why the other options are incorrect:** * **A. More common in females:** This is incorrect. Pilonidal sinus is significantly more common in **males** (ratio approx. 3:1 or 4:1), typically occurring after puberty due to increased hair growth and deeper natal clefts. * **B. Mostly congenital:** This is a historical misconception. It is now widely accepted as an **acquired** condition. It occurs when loose hairs are driven into the skin of the natal cleft by friction and vacuum effects (Jeep driver’s disease). * **C. Prognosis after surgery is poor:** This is incorrect. While recurrence can occur (around 10-15%), the overall prognosis is **good** if the tract is completely excised and postoperative hygiene (hair removal) is maintained. **High-Yield NEET-PG Pearls:** * **Risk Factors:** Obesity, sedentary lifestyle, deep natal cleft, and hirsutism. * **Pathogenesis:** Known as **"Jeep bottom"** or **"Jeep driver’s disease"** due to its prevalence in soldiers during WWII. * **Surgical Techniques:** Options include **Bascom’s procedure** (minimal excision), **Karydakis flap**, or **Limberg flap** (transposition flap) for complex or recurrent cases. * **Primary Aim:** The goal of surgery is to remove the "pith" (hair) and the epithelialized track. Simple incision and drainage are reserved only for acute abscesses, not definitive cure.
Question 468: All of the following are true about hernia surgery except:
- A. Surgery should not be done unless the patient becomes symptomatic. (Correct Answer)
- B. Hernia in children is treated with herniotomy.
- C. Absorbable mesh should not be used for surgery.
- D. Surgery can be done using laparoscopy.
Explanation: **Explanation:** The management of hernias is a cornerstone of general surgery. The correct answer is **Option A** because the traditional teaching of "watchful waiting" for asymptomatic inguinal hernias has largely been replaced by the recommendation for elective repair. While some elderly patients with minimal symptoms can be observed, the standard surgical principle is that **all hernias should be repaired** once diagnosed to prevent complications like incarceration or strangulation, which carry significantly higher morbidity and mortality. **Analysis of other options:** * **Option B (Herniotomy in children):** This is correct. In children, the etiology is a patent processus vaginalis (indirect hernia). Since the abdominal wall muscles are strong, only the sac needs to be excised (herniotomy); a repair (hernioplasty) is not required. * **Option C (Absorbable mesh):** This is correct. Permanent (non-absorbable) meshes like Polypropylene (Prolene) are the gold standard. Absorbable meshes lose their tensile strength over time, leading to a very high rate of recurrence, and are thus not used for standard hernia repair. * **Option D (Laparoscopy):** This is correct. Laparoscopic techniques (TEP - Totally Extraperitoneal or TAPP - Transabdominal Preperitoneal) are standard of care, especially for bilateral or recurrent hernias. **Clinical Pearls for NEET-PG:** * **Gold Standard Repair:** Lichtenstein tension-free mesh repair. * **Nerve most commonly injured:** Ilioinguinal nerve (during open surgery) and Genitofemoral nerve (during laparoscopy). * **Triangle of Pain:** Area lateral to the spermatic cord where nerves (Femoral, Genitofemoral, Lateral cutaneous nerve of thigh) are located; staples should be avoided here during laparoscopy. * **Femoral Hernia:** Highest risk of strangulation; always requires urgent surgery.
Question 469: In diabetic foot, which type of amputation is contraindicated?
- A. Ray amputation
- B. Forefoot amputation
- C. Syme's amputation (Correct Answer)
- D. Below knee amputation
Explanation: **Explanation:** The correct answer is **Syme’s amputation**. **Why Syme’s Amputation is Contraindicated:** Syme’s amputation is a disarticulation of the ankle joint with the removal of the malleoli and the preservation of the heel pad. In diabetic patients, this procedure is generally contraindicated due to **peripheral arterial disease (PAD)** and **microangiopathy**. The success of a Syme’s amputation depends entirely on the viability and blood supply of the posterior tibial artery to the heel pad. Since diabetic patients often have calcified vessels and poor distal perfusion, the heel pad frequently fails to heal, leading to necrosis, infection, and the need for a higher level of amputation. Additionally, diabetic neuropathy can lead to "heel pad migration," making the stump unstable for weight-bearing. **Analysis of Other Options:** * **Ray Amputation:** Commonly performed in diabetics for localized gangrene of a toe and its corresponding metatarsal head. It is indicated if the infection is limited. * **Forefoot (Transmetatarsal) Amputation:** A viable option if the gangrene involves multiple toes but the midfoot has adequate perfusion. * **Below Knee Amputation (BKA):** This is the most common major amputation in diabetics. It is preferred over Syme’s because the vascularity at the calf level is usually superior, ensuring better wound healing and excellent prosthetic fitting. **Clinical Pearls for NEET-PG:** * **Gold Standard for Diabetic Foot Assessment:** The **Wagner Classification** is used to grade the severity of the ulcer. * **Most common site for diabetic foot ulcer:** Plantar aspect of the first metatarsophalangeal joint. * **Vascularity Check:** An **Ankle-Brachial Index (ABI)** < 0.5 or a toe pressure < 30 mmHg indicates poor healing potential for distal amputations. * **Syme’s Amputation** is ideally suited for **trauma** in non-diabetic young patients with good vascularity.
Question 470: What is the most common complication following hemorrhoidectomy?
- A. Hemorrhage
- B. Infection
- C. Fecal impaction
- D. Urinary retention (Correct Answer)
Explanation: **Explanation:** **Urinary retention** is the most common complication following hemorrhoidectomy, occurring in approximately 10% to 15% of patients. The underlying mechanism is multifactorial: 1. **Reflex Spasm:** Pain and surgical manipulation in the perianal area lead to a reflex spasm of the internal urethral sphincter (mediated via the pelvic nerve plexus). 2. **Over-hydration:** Excessive intravenous fluid administration during surgery can lead to bladder over-distension. 3. **Anesthesia:** Spinal anesthesia, in particular, can temporarily inhibit the detrusor muscle reflex. **Analysis of Incorrect Options:** * **Hemorrhage:** While a significant concern, it is less common than urinary retention. Primary hemorrhage occurs within 24 hours (usually due to a slipped ligature), while secondary hemorrhage occurs 7–10 days post-op (due to sloughing of the pedicle). * **Infection:** The perianal area has a rich blood supply and high resistance to local flora; thus, frank abscess or cellulitis is rare. * **Fecal Impaction:** This is a common late complication often caused by postoperative pain and the use of opioid analgesics, but it occurs less frequently than acute urinary retention in the immediate postoperative period. **Clinical Pearls for NEET-PG:** * **Prevention:** Limiting perioperative fluids and providing adequate analgesia (e.g., pudendal blocks) reduces the risk of urinary retention. * **Anal Stenosis:** This is a late complication caused by excessive removal of the skin bridges between hemorrhoidal piles (Whitehead’s deformity). * **Milligan-Morgan:** This is the "Open" hemorrhoidectomy technique, whereas **Ferguson** is the "Closed" technique.
Practice by Chapter
Wound Healing and Care
Practice Questions
Surgical Infections
Practice Questions
Fluid and Electrolyte Management
Practice Questions
Nutrition in Surgical Patients
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Hemostasis and Blood Transfusion
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Surgical Instruments and Equipment
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Sutures and Stapling Devices
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Minimal Access Surgery Principles
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Surgical Complications
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Anesthesia Principles for Surgeons
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Surgical Oncology Principles
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Evidence-Based Surgery
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