General Surgery Principles Practice Questions

Q: Negative pressure dressing is used for which of the following indications?

Chronic non-healing diabetic ulcer. **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.

Q: Hydatid cyst occurs most commonly in which organ?

Liver. **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.

Q: The provided image is a thyroid scan. Based on the scan, what is the most probable diagnosis?

Hypersecreting adenoma. ***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.

Q: Reactionary hemorrhage occurs after extraction because of which of the following?

High blood pressure. **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.

Q: Which of the following statements about Pilonidal sinus is true?

Treatment of choice is surgical excision of the sinus tract. **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.

Q: In diabetic foot, which type of amputation is contraindicated?

Syme's amputation. **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.

Q: What is the most common complication following hemorrhoidectomy?

Urinary retention. **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.

Question 1

Negative pressure dressing is used for which of the following indications?

Accepted Answer

Chronic non-healing diabetic ulcer

Answer

Removal of eschar

Answer

Unexplored fistulas

Answer

Untreated osteomyelitis

Question 2

Hydatid cyst occurs most commonly in which organ?

Accepted Answer

Liver

Answer

Lung

Answer

Spleen

Answer

Brain

Question 3

The provided image is a thyroid scan. Based on the scan, what is the most probable diagnosis?

Accepted Answer

Hypersecreting adenoma

Answer

Papillary carcinoma of the thyroid

Answer

Lateral aberrant thyroid

Answer

Graves disease

Question 4

What is a keloid scar?

Accepted Answer

Excessive scar tissue that extends beyond the boundaries of the original incision or wound.

Answer

Excessive scar tissue that does not extend beyond the boundary of the original incision or wound.

Answer

Pale, flat, and stretched in appearance, often appearing on the back and in areas of tension.

Answer

Pale, flat, and stretched in appearance, often appearing on the chest and sternum and in areas of no tension.

Question 5

Reactionary hemorrhage occurs after extraction because of which of the following?

Accepted Answer

High blood pressure

Answer

Broken roots

Answer

Sharp interdental septum

Answer

Gingival laceration

Question 6

A Grade III wound is considered contaminated if it is:

Accepted Answer

A wound contaminated with gross fecal material spillage

Answer

An appendicular perforation

Answer

A wound in the urinary tract without unusual contamination

Answer

A surgical site with no unusual contamination

Question 7

Which of the following statements about Pilonidal sinus is true?

Accepted Answer

Treatment of choice is surgical excision of the sinus tract

Answer

More common in females

Answer

Mostly congenital

Answer

Prognosis after surgery is poor

Question 8

All of the following are true about hernia surgery except:

Accepted Answer

Surgery should not be done unless the patient becomes symptomatic.

Answer

Hernia in children is treated with herniotomy.

Answer

Absorbable mesh should not be used for surgery.

Answer

Surgery can be done using laparoscopy.

Question 9

In diabetic foot, which type of amputation is contraindicated?

Accepted Answer

Syme's amputation

Answer

Ray amputation

Answer

Forefoot amputation

Answer

Below knee amputation

Question 10

What is the most common complication following hemorrhoidectomy?

Accepted Answer

Urinary retention

Answer

Hemorrhage

Answer

Infection

Answer

Fecal impaction

General Surgery Principles — MCQs

General Surgery Principles — MCQs

On this page

Practice by Chapter

Want unlimited practice?