General Surgery Principles Practice Questions

Q: Which of the following sutures has maximum tensile strength and minimum tissue reaction?

Polypropylene. ***Polypropylene*** - Polypropylene is a **non-absorbable monofilament suture** known for its exceptional tensile strength and very low tissue reactivity. - Its **monofilament structure prevents bacterial harborage** and makes it suitable for vascular and cardiovascular surgeries where long-term strength is crucial. *Poliglecaprone* - Poliglecaprone (Monocryl) is a **synthetic absorbable monofilament suture** that offers good tensile strength initially but loses it rapidly over 2-3 weeks. - While it has minimal tissue reaction, its **absorbable nature** prevents it from maintaining long-term tensile strength. *Polyglactin* - Polyglactin (Vicryl) is a **synthetic absorbable braided suture** known for its high initial tensile strength that is retained for 2-3 weeks, with complete absorption in 56-70 days. - Its braided structure can lead to slightly more tissue reaction and a perceived higher risk of infection compared to monofilaments. *Polydioxanone* - Polydioxanone (PDS) is a **synthetic absorbable monofilament suture** that maintains its tensile strength for a longer period than other absorbable sutures (up to 6 weeks) but eventually degrades. - While it has good handling characteristics and low tissue reaction, its **absorbable nature** means it cannot provide permanent wound support.

Q: Most important factor in causation of ingrown toenail is?

Ill fitting shoes. ***Ill fitting shoes*** - **Tight or narrow shoes** compress the toes, pushing the soft tissue against the nail edge, leading to the nail growing into the skin. - This consistent pressure and irritation are a primary mechanical cause of **onychocryptosis**. *Fungal infection* - While fungal infections (onychomycosis) can cause nail thickening and deformity, they are not the primary cause of an ingrown toenail itself. - Fungal infections primarily affect the **nail plate** and **nail bed**, changing nail texture and color. *Genetic predisposition* - While certain **foot shapes** or **nail plate curvatures** may make an individual more prone to ingrown toenails, genetic factors are not the most direct or modifiable cause. - Genetic predisposition may increase susceptibility, but external factors like footwear are often the precipitating cause. *Nutritional deficiency* - Nutritional deficiencies can affect nail health, leading to brittleness, slow growth, or abnormal nail plates. - However, they do not directly cause the nail to **penetrate the surrounding skin**, which is the hallmark of an ingrown toenail.

Q: Which of the following is typical of rectus sheath hematoma?

Firm painful mass. ***Firm painful mass*** - A rectus sheath hematoma typically presents as a **firm, painful, and often well-circumscribed mass** within the abdominal wall. - The pain is usually localized to the site of the hematoma, often in the **lower quadrants of the abdomen**. *Bluish discoloration* - While some hematomas can cause skin discoloration, **bluish discoloration** (like a bruise) is possible but not the most defining or typical feature of a rectus sheath hematoma itself. - More often, the discoloration may be delayed or less prominent, especially with **deeper hematomas**. *Ecchymosis* - **Ecchymosis** (bruising) can occur with a rectus sheath hematoma if the bleeding is superficial or extensive enough to reach the skin. - However, it's not universally present and the defining characteristic is the presence of a **palpable mass**. *Severe tenderness* - **Severe tenderness** is certainly present, but it's part of the broader symptomology that includes a **palpable, firm mass**. - Without the presence of a mass, severe tenderness alone is less specific to rectus sheath hematoma compared to the combination of a **firm, painful mass**.

Q: Which of the following statements about umbilical hernias is true?

Most of the umbilical hernias disappear spontaneously. ***Most of the umbilical hernias disappear spontaneously*** - Umbilical hernias in infants and young children frequently close without intervention, often by the age of **2 to 3 years**, due to the natural strengthening of the abdominal wall. - This spontaneous closure is observed in a high percentage of cases, making watchful waiting a common and appropriate management strategy. *Most common content is small intestine* - The most common contents of an umbilical hernia are generally **omentum** or **a loop of large intestine**, not typically the small intestine. - The small intestine is more frequently seen in larger or complicated hernias, but not as the predominant content in most cases. *Males are affected more than females* - Umbilical hernias are actually observed **more frequently in females** than in males, although the difference can be slight in some populations. - They are also more common in **African Americans** and premature infants. *Surgical repair should be done at 1 year of age* - Surgical repair is generally recommended for umbilical hernias that **persist beyond 4 to 5 years of age**, are rapidly enlarging, or become symptomatic (e.g., pain, incarceration). - Repair at **1 year of age** is typically too early as most hernias at this age would still be expected to close spontaneously.

Q: Prolonged surgery time of vaginal hysterectomy may lead to damage to which of the following nerves?

Peroneal. ***Peroneal*** - Prolonged surgery time in the **lithotomy position**, often used for vaginal hysterectomy, can lead to compression of the **peroneal nerve (specifically the common peroneal nerve)** against the lateral aspect of the fibula head, causing neuropathy. - This compression is often due to sustained pressure from leg supports or stirrups during lengthy procedures. *Obturator* - The **obturator nerve** is located deep within the pelvis and is more commonly injured during dissection in the deep pelvic sidewalls or due to traction during procedures like lymphadenectomy. - Its injury is less typically associated with prolonged positioning during routine vaginal hysterectomy than the peroneal nerve. *Pudendal* - The **pudendal nerve** can be injured during vaginal delivery or prolonged compression from bike seats, but its injury during vaginal hysterectomy in the lithotomy position is less common than peroneal nerve injury. - While prolonged sitting can affect it, the direct compression mechanism seen with leg supports typically targets the peroneal nerve. *Sural* - The **sural nerve** is a sensory nerve in the calf and ankle and is generally not at high risk during vaginal hysterectomy performed in the lithotomy position. - Its common injury mechanisms include trauma to the lower leg or ankle surgery, not typically sustained positioning in the operating room.

Q: For how many weeks do cortisol levels typically remain elevated following a hemorrhage?

2 weeks. ***2 weeks*** - Following a hemorrhage, the **stress response** leads to elevated cortisol levels which typically persist for approximately **2 weeks**. - This sustained elevation is part of the body's adaptive response to trauma, influencing metabolism and immune function. *1 week* - While cortisol levels rise acutely after hemorrhage, they generally remain elevated for a longer period than just **1 week**. - A 1-week duration would be too short for the typical sustained systemic stress response. *3 weeks* - Cortisol levels usually begin to normalize or return closer to baseline around the **2-week** mark, making 3 weeks an overestimation of the typical sustained elevation. - Prolonged elevation beyond 2 weeks might suggest persistent stress or comorbidity, rather than a normal recovery trajectory. *4 weeks* - A 4-week elevation of cortisol following a single hemorrhage is generally considered an unusually prolonged response and is not typical. - Such an extended elevation could indicate a more severe or complicated clinical course, or a different underlying pathology.

Q: Which type of healing occurs in an incisional wound with infection?

Secondary. ***Secondary*** - **Infection** prevents immediate closure, requiring the wound to heal by **granulation, contraction, and epithelialization**. - This process leads to a larger scar compared to primary closure. - In an infected wound, closure would trap bacteria and lead to abscess formation, so the wound must heal by **secondary intention**. *Primary* - Occurs when wound edges are **cleanly approximated** without significant tissue loss or infection, allowing for direct re-epithelialization. - This leads to the **fastest healing** and **minimal scarring**. - Requires clean wound with minimal bacterial contamination. *Delayed primary* - Involves leaving the wound open initially (3-5 days) to allow for **drainage or reduction of contamination** in a potentially contaminated wound. - The wound is then **surgically closed before granulation tissue forms** once the risk of infection is reduced. - Also called **tertiary intention** by some authors. *Tertiary* - Refers to a wound that is initially left open to heal by **secondary intention with granulation tissue formation**. - The wound is then **closed surgically after granulation tissue has formed**. - Distinct from delayed primary closure, which occurs before granulation develops.

Q: Which of the following types of gangrene is least likely to be associated with diabetes?

Fournier's gangrene. Fournier's gangrene - This is a rare, life-threatening necrotizing fasciitis of the perineum and genital area, which can occur in people with diabetes but is not primarily or exclusively associated with the systemic vascular or neuropathic complications that lead to the other common types of gangrene in diabetic patients. - While diabetes is a risk factor for Fournier's gangrene due to immunosuppression, it's not a direct consequence of the typical diabetic microvascular or macrovascular disease processes that predominantly cause dry or wet gangrene [1]. Wet gangrene - This type of gangrene is highly associated with diabetes, often resulting from a combination of poor circulation, neuropathy, and infection in a moist environment [1]. - In diabetic patients, impaired immune function and high glucose levels create a favorable environment for bacterial growth, leading to rapid tissue destruction and liquefaction [1]. Dry gangrene - This is very common in diabetes due to the underlying atherosclerosis and peripheral artery disease, which lead to chronic ischemia without significant bacterial infection [1]. - Reduced blood flow, particularly to the extremities, causes tissue death and often results in a shriveled, dark, and mummified appearance [1]. Gas gangrene - Diabetics are at increased risk for gas gangrene due to their compromised immune systems and the development of wounds amenable to infection by Clostridium species [1]. - This rapid and aggressive infection is characterized by the production of gas in tissues and can arise from even minor trauma or surgical wounds in diabetic patients.

Q: Which of the following is NOT a criterion for the viability of muscle?

Intact fascia. ***Intact fascia*** - The **fascia** is a connective tissue sheath surrounding muscles; its intactness is **not a direct indicator of muscle viability**. - While important for muscle integrity and function, a healthy, viable muscle can still exist even if its overlying fascia is disrupted or surgically opened. *Colour* - **Healthy muscle** generally has a **reddish-pink colour** due to its rich blood supply and myoglobin content. - **Pale, dusky, or black muscle** suggests **ischemia or necrosis**, indicating poor viability. *Contractility* - **Viable muscle** should be able to **contract** in response to direct electrical stimulation or mechanical irritation. - The **absence of contractility** indicates **muscle death or severe damage**, making it non-viable. *Bleeding when cut* - **Viable muscle** has an **intact blood supply** and will **bleed when incised**. - **Lack of bleeding** suggests **severe ischemia or necrosis**, indicating the muscle is non-viable.

Q: The image below shows a pressure sore. Which stage does this belong to?

Stage 4. ***Stage 4*** - The image clearly shows **extensive tissue loss**, including exposed bone and muscle, indicating a **deep tissue injury**. - The presence of large areas of **dead tissue (eschar)**, undermining, and tunneling are characteristic features of a stage 4 pressure sore. *Stage 1* - This stage involves **intact skin** with non-blanchable redness, indicating only superficial damage. - There is no **break in the skin** or tissue loss in Stage 1 pressure sores. *Stage 2* - Characterized by **partial-thickness skin loss**, presenting as an open blister or shallow ulcer. - **No visible deeper tissue** such as fat, muscle, or bone is exposed in this stage. *Stage 3* - Involves **full-thickness skin loss** with visible subcutaneous fat, but bone, tendon, or muscle are not exposed. - While there may be **undermining or tunneling**, the deep structures are not yet visible as seen in the image.

Question 1

Which of the following sutures has maximum tensile strength and minimum tissue reaction?

Accepted Answer

Polypropylene

Answer

Poliglecaprone

Answer

Polydioxanone

Answer

Polyglactin

Question 2

Most important factor in causation of ingrown toenail is?

Accepted Answer

Ill fitting shoes

Answer

Fungal infection

Answer

Genetic predisposition

Answer

Nutritional deficiency

Question 3

Which of the following is typical of rectus sheath hematoma?

Accepted Answer

Firm painful mass

Answer

Bluish discoloration

Answer

Ecchymosis

Answer

Severe tenderness

Question 4

Which of the following statements about umbilical hernias is true?

Accepted Answer

Most of the umbilical hernias disappear spontaneously

Answer

Males are affected more than females

Answer

Most common content is small intestine

Answer

Surgical repair should be done at 1 year of age

Question 5

Prolonged surgery time of vaginal hysterectomy may lead to damage to which of the following nerves?

Accepted Answer

Peroneal

Answer

Obturator

Answer

Sural

Answer

Pudendal

Question 6

For how many weeks do cortisol levels typically remain elevated following a hemorrhage?

Accepted Answer

2 weeks

Answer

1 week

Answer

3 weeks

Answer

4 weeks

Question 7

Which type of healing occurs in an incisional wound with infection?

Accepted Answer

Secondary

Answer

Primary

Answer

Delayed primary

Answer

Tertiary

Question 8

Which of the following types of gangrene is least likely to be associated with diabetes?

Accepted Answer

Fournier's gangrene

Answer

Dry gangrene

Answer

Wet gangrene

Answer

Gas gangrene

Question 9

Which of the following is NOT a criterion for the viability of muscle?

Accepted Answer

Intact fascia

Answer

Contractility

Answer

Colour

Answer

Bleeding when cut

Question 10

The image below shows a pressure sore. Which stage does this belong to?

Accepted Answer

Stage 4

Answer

Stage 1

Answer

Stage 2

Answer

Stage 3

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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