General Surgery Principles Practice Questions

Q: Which of the following statements about fresh frozen plasma (FFP) is false?

To be used within 30 minutes of having trauma. ***To be used within 30 minutes of having trauma*** - This statement is false because while **fresh frozen plasma (FFP)** should be administered promptly in trauma or massive transfusion protocols, there is no strict "30-minute rule" from the moment of trauma. The promptness depends on the patient's **hemodynamic stability** and **coagulopathy** assessment. - FFP must be thawed before administration, which can take 20-30 minutes, making administration within 30 minutes of the traumatic event often impractical and not a general guideline. *Supplies major coagulation factors* - **Fresh frozen plasma (FFP)** is rich in all coagulation factors, including **Factor V**, **Factor VIII**, and **fibrinogen**, which are vital for hemostasis. - This makes it an essential blood product for patients with multiple coagulation factor deficiencies, such as those with **liver disease** or undergoing massive transfusions. *ABO match not required* - This statement is incorrect. While plasma contains less cellular material, it still contains **ABO antibodies** which can cause transfusion reactions if not matched. - **ABO compatibility** is crucial for FFP transfusions to prevent hemolytic reactions from transfused antibodies reacting with recipient red blood cells. *Should be used in replacement of factors in DIC / trauma* - **Fresh frozen plasma (FFP)** is indicated for the replacement of multiple clotting factors in conditions like **disseminated intravascular coagulation (DIC)**, especially when there is active bleeding or a high risk of bleeding [1]. - In massive trauma, FFP is a crucial component of **massive transfusion protocols** to correct acute coagulopathy caused by blood loss and dilution [1].

Q: What is true about keloids?

It appears weeks to months after surgery.. ***It appears weeks to months after surgery.*** - Keloids typically develop **weeks to months** after the initial injury or surgery, reflecting their nature as a **delayed abnormal healing response**. - Their delayed appearance is due to the **overgrowth of collagen** during the prolonged healing process. - This distinguishes them from normal wound healing and even hypertrophic scars. *It appears immediately after surgery.* - Keloids are a form of **abnormal wound healing** that occurs long after the initial injury, not immediately. - The immediate post-surgical period involves normal wound closure and initial inflammatory responses, not keloid formation. *It is limited in its distribution.* - Keloids are characterized by their tendency to **grow beyond the original wound margins**, unlike hypertrophic scars which remain confined to the wound site. - They can occur in various locations on the body, especially common in areas like the **chest, shoulders, earlobes, and upper back**. *It is common in older people.* - Keloids are more prevalent in **younger individuals**, typically between **10 and 30 years of age**. - The incidence decreases with age, and they are **rarely seen in very young children** or the elderly.

Q: What is the primary use of crocus cloth in medical applications?

Polishing surgical instruments. ***Polishing surgical instruments*** - **Crocus cloth** is a very fine abrasive material primarily used for achieving a high polish on **metals**, including those used in surgical instruments. - This polishing action helps to ensure the instruments are smooth, free of imperfections, and less likely to harbor microorganisms, promoting **sterilization** and longevity. *Finishing wood surfaces* - While crocus cloth can smooth surfaces, its primary application is not **wood finishing**; other abrasives like **sandpaper** are more commonly used for this purpose. - Finishing wood typically requires a range of grits to progressively smooth the surface, which is not the main role of crocus cloth. *Cleaning metal surfaces* - **Crocus cloth** is used for polishing, which involves removing very fine surface imperfections and achieving a shine, rather than rough **cleaning** of heavily soiled metal surfaces. - For generalized cleaning, **solvents** or other abrasive cleaners might be employed, depending on the type and extent of contamination. *Sanding surfaces* - **Sanding** generally implies a more aggressive removal of material or preparation of a surface for coating, using coarser **abrasives**. - Crocus cloth is an extremely fine abrasive suitable for final polishing, not for general **sanding** or initial material removal.

Q: In a sutured surgical wound, the process of epithelialization is completed within what timeframe?

48 hours. ***48 hours*** - **Epithelialization** in a clean, sutured surgical wound is typically completed within **48 hours**, forming a complete protective epithelial barrier. - This timeframe is crucial for preventing external contaminants from entering the wound and marks when the wound can be safely exposed to water. *Less than 48 hours* - While initial **epithelial migration** begins within hours of wound closure, **complete epithelialization** with a fully formed protective barrier requires up to **48 hours**. - The wound remains vulnerable to bacterial penetration if exposed to contaminants before the epithelial barrier is complete. *More than 72 hours* - If **epithelialization** takes **more than 72 hours** in a simple sutured wound, it indicates impaired healing, possible wound complications, or infection. - Prolonged epithelialization beyond this timeframe suggests deviation from the normal wound healing process. *More than 48 hours but less than 72 hours* - Although wound strength continues to increase through collagen deposition over weeks, the primary protective **epithelial barrier** is established by **48 hours**. - The completion of epithelialization within 48 hours is the standard timeframe for primary intention healing in sutured wounds.

Q: Most common type of shock in surgical practice:

Hypovolemic. ***Hypovolemic*** - **Blood loss** during surgery (hemorrhage) is a common occurrence, leading to a significant reduction in circulating blood volume. - Furthermore, **fluid shifts** and **third-spacing** in scenarios like bowel obstruction, burns, or peritonitis also contribute to decreased effective circulating volume. *Cardiogenic* - This type of shock is due to the heart's inability to pump enough blood, often from a **myocardial infarction** or **severe heart failure**. - While it can occur in surgical patients, it's less frequent as the primary cause compared to blood or fluid loss. *Septic shock* - Occurs due to a **severe systemic infection** leading to widespread inflammation and vasodilation. - Although surgical patients are at risk for infection, particularly post-operatively, it is not the most common initial type of shock encountered during or immediately after surgery. *Neurogenic* - Results from **spinal cord injury** or other damage to the central nervous system, leading to a loss of sympathetic tone and profound vasodilation. - This is a less common cause of shock in general surgical practice compared to hypovolemia unless specific neurological trauma is involved.

Q: What is Cock's peculiar tumor?

Ulceration of a sebaceous cyst. ***Ulceration of a sebaceous cyst*** - **Cock's peculiar tumor** is an older term used to describe a **neglected**, **infected**, and **ulcerating sebaceous cyst** that has eroded through the skin. - Over time, these cysts can become secondarily infected and inflamed, leading to rupture and the formation of a chronic ulcer. *Calcifying epithelioma (Pilomatrixoma)* - This is a **benign tumor** of the hair matrix, presenting as a firm, solitary nodule, most common in the head and neck. - It is characterized by **calcification** and is not typically associated with ulceration as a primary feature, nor does it originate from a sebaceous cyst. *Mesothelioma of the pleura* - This is a **malignant tumor** arising from the mesothelial cells lining the pleura, often associated with **asbestos exposure**. - It is an internal malignancy affecting the lungs and pleura, completely unrelated to skin lesions or sebaceous cysts. *Osteomyelitis of the skull* - This is an **infection of the bone** in the skull, usually caused by bacteria, leading to bone destruction and inflammation. - While it can present with swelling and pain, it is a primary bone infection and not related to sebaceous cysts or skin lesions.

Q: Closure for clean wounds within 6 hours of injury is called.

Primary closure. ***Primary closure*** - **Primary closure** is the immediate closure of a wound, typically within **6 hours** of injury, for **clean wounds** at low risk of infection. - This method promotes direct apposition of wound edges, leading to **faster healing** and **minimal scarring**. *Delayed primary closure* - This involves leaving a wound open for **4-6 days** to monitor for infection or edema, then closing it if conditions are favorable. - It is often used for **contaminated wounds** or those with a higher risk of infection, where immediate closure is not safe. - Also known as **tertiary closure**. *Secondary closure* - **Secondary closure**, or healing by secondary intention, occurs when a wound is left open and allowed to **heal naturally by granulation, contraction, and epithelialization**. - This method is used for **heavily contaminated** or **infected wounds** and results in a larger scar and a longer healing time. *Tertiary closure* - **Tertiary closure** is another term for **delayed primary closure**. - It involves leaving a wound open initially, then closing it after several days (typically 4-6 days) once the risk of infection has decreased. - This option is incorrect because the question asks about closure **within 6 hours**, not delayed closure.

Q: Rapid polymerization with high intensity light will:

Decrease bond strength by increasing stresses. ***Decrease bond strength by increasing stresses*** - Rapid polymerization with **high-intensity light** leads to a **faster gel point conversion** and a rapid increase in viscosity. - This rapid setting traps internal stresses within the **polymerized material** due to **volumetric shrinkage**, preventing proper stress relief and leading to higher internal stresses, which ultimately **reduces bond strength**. *Increase bond strength by decreasing stresses* - This statement is incorrect because rapid polymerization during high-intensity light curing causes a rapid increase in **polymerization shrinkage stress**. - **Increased stresses** within the material will tend to **reduce bond strength**, not increase it, as the material is less able to relax these stresses. *No effect on bond strength* - This is incorrect as the **rate of polymerization** directly influences the development of **stress** within the composite material. - **High-intensity light curing** affects the **kinetics of polymerization**, leading to significant changes in **mechanical properties** like bond strength. *Initial increase followed by a decrease in bond strength* - While there is an initial increase in **mechanical properties** as the material polymerizes, the **high stress levels** generated by rapid polymerization with high intensity light cause a net decrease in the **ultimate bond strength**. - The rapid formation of a **cross-linked network** under high intensity light creates a stiff material that cannot effectively relieve internal stresses, leading to **weakened bonds**.

Q: Which of the following statements is true regarding intra-abdominal compartment syndrome?

All of the options. ***All of the options*** - All statements provided accurately describe aspects of intra-abdominal compartment syndrome or factors influencing intra-abdominal pressure. - **Intra-abdominal compartment syndrome (ACS)** is defined by a sustained IAP **greater than 20 mmHg** associated with **new organ dysfunction**. - **Intra-abdominal hypertension** is defined as an IAP persistently ≥12 mmHg. *Pneumoperitoneum can increase intra-abdominal pressure but is not a common cause* - While **pneumoperitoneum**, particularly during laparoscopic surgery, does increase IAP, it is typically a **controlled and transient** increase. - This makes it an uncommon cause of sustained, pathological intra-abdominal compartment syndrome. - The gas is usually absorbed or released, preventing the prolonged high pressures seen in other etiologies like severe ascites, hemorrhage, or aggressive fluid resuscitation. *Renal blood flow is affected* - Elevated intra-abdominal pressure **reduces renal perfusion pressure** and compresses renal veins and parenchyma, leading to decreased renal blood flow. - This results in **oliguria or anuria** and is a critical component of the **organ dysfunction** defining ACS. - Often leads to acute kidney injury if not promptly addressed. *Intra-abdominal pressure > 20 mmHg with new organ dysfunction* - This is the **complete definition** of intra-abdominal compartment syndrome. - The combination of **sustained IAP > 20 mmHg** plus **new organ dysfunction/failure** distinguishes ACS from intra-abdominal hypertension alone. - Organ dysfunction may manifest as renal failure, respiratory compromise, decreased cardiac output, or abdominal perfusion pressure < 60 mmHg.

Q: Concentrated alcohol-based antiseptics for skin preparation of the operative site lead to

>95% reduction in bacterial count. ***>95% reduction in bacterial count*** - Concentrated **alcohol-based antiseptics**, particularly those containing concentrations like **70% isopropyl alcohol**, are highly effective in achieving a **significant log reduction** of bacterial flora on the skin. - This **high bactericidal activity** is crucial for minimizing surgical site infections by rapidly destroying bacterial cell membranes. * >50% reduction in bacterial count - While a >50% reduction is positive, it underestimates the actual efficacy of properly applied **concentrated alcohol-based antiseptics**. - These agents are known to provide a much more substantial and rapid reduction in **bacterial load** than just over half. * <50% reduction in bacterial count - This option is incorrect because **alcohol-based antiseptics** are well-established to provide a very high level of **skin decolonization** when used correctly. - A reduction of less than 50% would indicate a product with poor efficacy, which is contrary to the known properties of these solutions. * Contraindicated for operative site - This is incorrect; **alcohol-based antiseptics** are the **standard of care** for **surgical site preparation** due to their rapid and broad-spectrum antimicrobial activity. - They are contraindicated in specific situations (e.g., mucous membranes, open wounds, patients with alcohol sensitivity), but not for the general operative site.

Question 1

Which of the following statements about fresh frozen plasma (FFP) is false?

Accepted Answer

To be used within 30 minutes of having trauma

Answer

ABO match not required

Answer

Supplies major coagulation factors

Answer

Should be used in replacement of factors in DIC / trauma

Question 2

What is true about keloids?

Accepted Answer

It appears weeks to months after surgery.

Answer

It appears immediately after surgery.

Answer

It is limited in its distribution.

Answer

It is common in older people.

Question 3

What is the primary use of crocus cloth in medical applications?

Accepted Answer

Polishing surgical instruments

Answer

Finishing wood surfaces

Answer

Cleaning metal surfaces

Answer

Sanding surfaces

Question 4

In a sutured surgical wound, the process of epithelialization is completed within what timeframe?

Accepted Answer

48 hours

Answer

Less than 48 hours

Answer

More than 72 hours

Answer

More than 48 hours but less than 72 hours

Question 5

Most common type of shock in surgical practice:

Accepted Answer

Hypovolemic

Answer

Cardiogenic

Answer

Septic shock

Answer

Neurogenic

Question 6

What is Cock's peculiar tumor?

Accepted Answer

Ulceration of a sebaceous cyst

Answer

Calcifying epithelioma (Pilomatrixoma)

Answer

Mesothelioma of the pleura

Answer

Osteomyelitis of the skull

Question 7

Closure for clean wounds within 6 hours of injury is called.

Accepted Answer

Primary closure

Answer

Delayed primary closure

Answer

Secondary closure

Answer

Tertiary closure

Question 8

Rapid polymerization with high intensity light will:

Accepted Answer

Decrease bond strength by increasing stresses

Answer

No effect on bond strength

Answer

Initial increase followed by a decrease in bond strength

Answer

Increase bond strength by decreasing stresses

Question 9

Which of the following statements is true regarding intra-abdominal compartment syndrome?

Accepted Answer

All of the options

Answer

Pneumoperitoneum can increase intra-abdominal pressure but is not a common cause.

Answer

Renal blood flow is affected.

Answer

Intra-abdominal pressure > 20 mmHg with new organ dysfunction

Question 10

Concentrated alcohol-based antiseptics for skin preparation of the operative site lead to

Accepted Answer

>95% reduction in bacterial count

Answer

>50% reduction in bacterial count

Answer

<50% reduction in bacterial count

Answer

Contraindicated for operative site

General Surgery Principles — MCQs

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