General Surgery Principles Practice Questions

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.

Q: Identify the surgical instrument based on the following characteristics: short blades, sharp cutting edges, and a central screw or rivet. Commonly used for cutting sutures.

Suture Scissors. ***Suture Scissors*** - Characterized by **short, sharp blades** and a central screw, making them ideal for precision cutting of sutures. - Their design allows for a **clean cut** through suture material without fraying, which is crucial in surgical settings. - Also known as **stitch scissors** or suture removal scissors, commonly used for cutting sutures during wound closure or suture removal. *Metzenbaum Scissors* - Known for their **long, slender shafts** and delicate blades, primarily used for **dissecting delicate tissues**. - Designed for blunt and sharp dissection of fine tissues rather than suture cutting. - Their longer, more delicate design makes them less ideal for the quick, precise cutting required for suture removal. *Mayo Scissors* - Possess **sturdy, heavy blades** that can be straight or curved, designed for cutting **tough tissues**, fascia, and heavy sutures. - Their robust construction is designed for cutting dense tissue rather than the fine, precise work of routine suture cutting. - Available in straight (for cutting sutures on skin) and curved (for cutting deep tissues) varieties. *Iris Scissors* - These are very **fine, delicate scissors** with extremely sharp, pointed tips, mainly used in **ophthalmic surgery** and other microsurgical procedures. - While they **can cut fine sutures** (6-0, 7-0) with precision, they are more specialized for delicate tissue dissection. - Their very fine tips make them less suitable as general-purpose suture scissors compared to dedicated stitch scissors.

Q: What type of knot is depicted in the image?

Granny knot. ***Granny knot*** - The image shows a knot where the two half-knots are tied in the **same direction** (left over right, then left over right again, or vice versa), causing it to be unstable and slip. - This instability makes it less secure than a reef knot, as the two end pieces emerge parallel but on opposite sides of the loop. - The granny knot is an **insecure knot** that should be avoided in surgery as it can spontaneously untie. *Surgeon's knot* - A surgeon's knot involves an **extra throw** (double wrap) around the first loop to increase friction and make it more secure, which is not depicted here. - It is typically used to ensure that the first throw holds tension while the second throw is being tied. *Reef knot* - A reef knot (or square knot) is formed by tying two half-knots in **opposite directions** (left over right, then right over left), which creates a flat, stable, and secure knot. - In a reef knot, the two end pieces emerge parallel and on the same side of the loop, unlike the granny knot. *Half hitch* - A half hitch is a simple overhand knot around a standing part of the rope, used as a single throw or in combination with other knots. - It is not the same as the double-throw configuration shown in the image.

Q: Which of the following statements is true about the suture material shown in the image?

Degraded by enzymatic degradation. ***Degraded by enzymatic degradation*** - Catgut sutures are **natural absorbable sutures** made primarily from purified collagen. - Their absorption in the body occurs through **enzymatic degradation** and phagocytosis, which is a key characteristic distinguishing them from synthetic absorbable sutures that undergo hydrolysis. *Made of cat submucosa* - While historically referred to as "catgut," these sutures are not actually made from cat intestines. - They are typically derived from the **submucosa of sheep or goat intestines**. *Not degraded* - Catgut sutures are explicitly classified as **absorbable surgical sutures**, as stated on the packaging. - Absorbable sutures by definition are designed to be broken down and **resorbed by the body** over time. *Made of rabbit submucosa* - Catgut sutures are not typically made from rabbit submucosa. - The primary sources for natural absorbable sutures like catgut are the **intestines of sheep or goats**.

Q: Identify the type of retractor shown in the image.

Weitlaner retractor. ***Weitlaner retractor*** - The image displays a **self-retaining retractor** with two sets of curved blades with sharp prongs, which is characteristic of a Weitlaner retractor. - **Weitlaner retractors** are commonly used in various surgical procedures, particularly in orthopedic, neurosurgical, and superficial soft tissue surgeries, to hold back wound edges for better visualization. - They feature a self-retaining mechanism with a ratchet lock and typically have 2-3 prongs on each blade. *Czerny retractor* - A **Czerny retractor** is a handheld, double-ended retractor with L-shaped blades of different sizes, not a self-retaining type as shown. - It is typically used for retracting shallow or superficial tissues in abdominal surgery. *Richardson retractor* - A **Richardson retractor** is a handheld, single-ended retractor with a curved lip, often used for deep tissue retraction in abdominal surgeries. - It does not have the self-retaining mechanism or multiple-pronged blades seen in the image. *Lower lid retractor* - A **lower lid retractor** is a small, specialized retractor designed for ophthalmic surgery to retract the eyelid, and its shape is distinct from the instrument shown. - It is much smaller and has a smooth, curved blade to fit the contour of the eyelid.

Q: Which of the following statements about keloids is MOST true?

Keloids may extend beyond the original wound.. ***Keloids may extend beyond the original wound.*** - Keloids are characterized by their **overgrowth** beyond the boundaries of the original injury. - This distinguishes them from **hypertrophic scars**, which remain confined to the wound edges. *Extended excision is often not the treatment of choice.* - **Excision alone** is usually insufficient for keloids and can even be counterproductive, as the recurring wound often leads to a larger keloid. - While excision can be part of a treatment plan, it is typically combined with supplementary therapies like **steroid injections** or **radiation therapy** to prevent recurrence. *It contains growth factors.* - While keloids involve abnormal fibroblast activity and deposition of **extracellular matrix**, the statement that it "contains growth factors" is too vague and not a defining characteristic that differentiates it from a range of other tissues or conditions. - Many tissues and healing processes involve growth factors, so this statement alone does not provide a specific or most true characteristic of keloids. *None of the options.* - This option is incorrect because the statement that **keloids may extend beyond the original wound** is a hallmark characteristic of keloids and is definitively true.

Q: Which of the following is NOT a principle of negative pressure wound therapy?

Clearance of infection. ***Clearance of infection*** - While negative pressure wound therapy (NPWT) can help manage heavily colonized wounds by removing exudate and reducing bacterial burden, it is **not a primary treatment for active infection**. - **Systemic antibiotics** or local antiseptics are required to truly clear an infection, as NPWT alone cannot eliminate deep-seated pathogens. *Stabilization of wound environment* - NPWT helps to **stabilize the wound bed** by holding it in place, protecting it from external contamination and mechanical stress. - This creates an optimal environment for **wound healing** by preventing disruption of newly formed granulation tissue. *Macrodeformation of the wound* - The negative pressure applied to the wound surface causes the wound edges to be drawn together, leading to **macrodeformation**. - This effect reduces wound size and promotes **epithelialization** and **wound contraction**. *Decreased edema* - NPWT actively removes **excess interstitial fluid** and exudate from the wound bed, leading to a significant reduction in edema. - This reduction in swelling improves **perfusion** to the wound tissues and promotes better healing.

Q: What is the typical absorption duration of Polydioxanone sutures?

6 months. ***Correct: 6 months*** - **Polydioxanone (PDS) sutures** are known for their **prolonged absorption time**, typically ranging from 180 to 210 days, or approximately 6 months. - This characteristic makes PDS sutures suitable for tissues requiring **extended support** during the healing process. - PDS retains approximately **50% tensile strength at 4 weeks** and **25% at 6 weeks**, with complete absorption occurring over 6-7 months. *Incorrect: 2 weeks* - An absorption duration of 2 weeks is characteristic of **rapidly absorbing sutures**, such as **chromic gut** or **fast-absorbing synthetic sutures**, which are used for tissues that heal quickly or require minimal support. - PDS sutures offer much longer tensile strength retention and absorption than this brief period. *Incorrect: 4 weeks* - A 4-week absorption time is considerably shorter than that of PDS sutures. This duration might be seen with some **intermediate-absorbing sutures**, but not with the long-lasting PDS. - Sutures absorbed in this timeframe would not provide sufficient support for tissues where PDS is typically indicated. *Incorrect: 6 weeks* - While longer than 2 or 4 weeks, 6 weeks (approximately 42 days) is still much shorter than the typical absorption profile of PDS sutures. - Sutures like **Vicryl Rapide** might fall into this absorption range, but PDS is designed for applications needing several months of support.

Q: An Incisional wound heals by

Primary Healing. ***Primary Healing*** - An **incisional wound** is typically a clean, sharply incised wound with **minimal tissue loss** and edges that can be approximated. - **Primary healing** (or first intention) occurs when the wound edges are surgically closed, leading to rapid healing with minimal scarring. *Secondary Healing* - This type of healing occurs in wounds with **significant tissue loss** or infection, where the edges cannot be approximated. - The wound must heal by **granulation tissue formation** and **wound contraction**, resulting in a larger scar. *Epithelialization* - **Epithelialization** is a vital process in all types of wound healing, where epithelial cells migrate to cover the wound surface. - However, it describes a *process* rather than a *mode* of overall wound healing for a closed incisional wound. *Delayed primary Healing* - **Delayed primary healing** (or tertiary intention) involves leaving a wound open for a period (e.g., to control infection or edema) before closing it surgically. - This approach is not typical for a clean incisional wound but is used in cases where primary closure is initially unsafe.

Q: Which type of surgical suture is known to cause the most tissue reaction?

Silk. ***Silk*** - Silk is a **natural, braided, non-absorbable suture** that is known to elicit a significant **inflammatory reaction** due to its natural protein composition and braided structure. - While it was historically used for its good handling properties, its high tissue reactivity makes it less ideal for situations where minimal scarring or inflammation is desired. - **Silk causes the most tissue reaction** among commonly used sutures. *Plain Catgut* - Plain catgut is a **natural, absorbable suture** derived from purified collagen of animal intestines, causing a moderate to high tissue reaction. - However, its absorption by enzymatic hydrolysis is relatively rapid, limiting the duration of the inflammatory response compared to non-absorbable natural materials like silk. *Polydiaxonone* - Polydiaxonone (PDS) is a **synthetic, monofilament, absorbable suture** known for causing a relatively **low tissue reaction**. - Its slow absorption profile and monofilament structure contribute to its minimal inflammatory response, making it suitable for tissues requiring prolonged support. *Chromic Catgut* - Chromic catgut is a treated form of plain catgut that has been coated with chromium salts, which prolong its absorption time and reduce its tissue reactivity compared to plain catgut. - Although it is still a natural, absorbable suture, its tissue reaction is **less than both plain catgut and silk**, but greater than synthetic monofilament sutures like PDS.

Question 1

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

Question 2

Identify the surgical instrument based on the following characteristics: short blades, sharp cutting edges, and a central screw or rivet. Commonly used for cutting sutures.

Accepted Answer

Suture Scissors

Answer

Metzenbaum Scissors

Answer

Mayo Scissors

Answer

Iris Scissors

Question 3

What type of knot is depicted in the image?

Accepted Answer

Granny knot

Answer

Half hitch

Answer

Surgeon’s knot

Answer

Reef knot

Question 4

Which of the following statements is true about the suture material shown in the image?

Accepted Answer

Degraded by enzymatic degradation

Answer

Made of cat submucosa

Answer

Not degraded

Answer

Made of rabbit submucosa

Question 5

Identify the type of retractor shown in the image.

Accepted Answer

Weitlaner retractor

Answer

Czerny retractor

Answer

Richardson retractor

Answer

Lower lid retractor

Question 6

Which of the following statements about keloids is MOST true?

Accepted Answer

Keloids may extend beyond the original wound.

Answer

Extended excision is often not the treatment of choice.

Answer

It contains growth factors.

Answer

None of the options.

Question 7

Which of the following is NOT a principle of negative pressure wound therapy?

Accepted Answer

Clearance of infection

Answer

Macrodeformation of the wound

Answer

Decreased edema

Answer

Stabilization of wound environment

Question 8

What is the typical absorption duration of Polydioxanone sutures?

Accepted Answer

6 months

Answer

4 weeks

Answer

6 weeks

Answer

2 weeks

Question 9

An Incisional wound heals by

Accepted Answer

Primary Healing

Answer

Secondary Healing

Answer

Epithelialization

Answer

Delayed primary Healing

Question 10

Which type of surgical suture is known to cause the most tissue reaction?

Accepted Answer

Silk

Answer

Plain Catgut

Answer

Polydiaxonone

Answer

Chromic catgut

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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