General Surgery Principles Practice Questions

Q: A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Absorbed by phagocytosis and enzymatic degradation. ***Absorbed by phagocytosis and enzymatic degradation*** - The image shows a **braided absorbable suture**, which undergoes absorption through **tissue reaction** involving enzymatic breakdown and phagocytosis - This is the characteristic mechanism of absorption for most **absorbable sutures** (both natural like catgut and synthetic like Vicryl, Monocryl, PDS) - The body's macrophages phagocytose suture particles while proteolytic enzymes break down the material components, allowing complete removal from tissues *Derived from catgut* - While **catgut sutures** (derived from sheep/bovine intestinal submucosa) are absorbable, modern synthetic absorbable sutures like **polyglactin (Vicryl)** or **polyglycolic acid (Dexon)** are more commonly used - The image appearance and braided structure suggest a synthetic absorbable suture rather than catgut - Catgut is less commonly used today due to higher tissue reactivity and unpredictable absorption *Non-absorbable* - **Non-absorbable sutures** (silk, nylon, polypropylene) remain permanently in tissues or require removal - The mechanism of absorption by phagocytosis and enzymatic degradation specifically defines **absorbable sutures**, making this option incorrect - Non-absorbable sutures maintain tensile strength indefinitely *Absorbed over 3 months* - Absorption time varies significantly by suture type: **rapidly absorbing gut (5-7 days)**, **Vicryl (56-70 days)**, **PDS (180-210 days)** - While some sutures absorb around 90 days, this is not a universal characteristic - The statement is too specific and not applicable to all absorbable sutures shown

Q: The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Nyhus Type IIIB. ***Nyhus Type IIIB*** - The image shows a hernia occurring within **Hesselbach's triangle**, which is the anatomical site for a **direct inguinal hernia**. A direct inguinal hernia is classified as **Nyhus Type III**, as it involves a defect in the posterior wall of the inguinal canal, medial to the inferior epigastric vessels. - The "B" in Nyhus Type IIIB specifically denotes a **direct inguinal (III) hernia with a weakness in the posterior inguinal wall**. While the question asks for the specific Nyhus classification, options like Nyhus Type I, Type II, and Type IIIA, as well as a femoral hernia (Nyhus Type IV), are inconsistent with the highlighted location. *Nyhus Type I* - This classification refers to an **indirect inguinal hernia** where the internal ring is normal, typically seen in children. - It would originate lateral to the inferior epigastric artery, unlike the highlighted region. *Nyhus Type II* - This type describes an **indirect inguinal hernia** with an enlarged internal ring but an intact posterior inguinal wall. - This type of hernia would still originate lateral to the inferior epigastric vessels, not within Hesselbach's triangle. *Nyhus Type IIIA* - Nyhus Type IIIA specifically classifies an **indirect inguinal hernia** with an enlarged internal ring and a completely destructed transversalis fascia. - While it's also a Type III (indirect), Type IIIA refers to an indirect hernia, which emerges lateral to the inferior epigastric vessels, whereas a direct hernia (within Hesselbach's triangle) emerges medial to these vessels. *Nyhus Type IV* - This classification is for a **femoral hernia**, which occurs inferior to the inguinal ligament and through the femoral canal. - The highlighted area is clearly superior to the inguinal ligament and within the inguinal region, not the femoral region.

Q: Identify the instrument shown in the image, which is a lumbar puncture needle with a sharp cutting edge and a hub indicating CSF.

Quincke's needle. ***Quincke's needle*** - This image shows a **Quincke's needle**, which is a type of spinal needle commonly used for lumbar punctures. - It features a **sharp, beveled cutting edge** designed to cut through tissue layers, and the hub allows for CSF flow immediately upon entry into the subarachnoid space. - Quincke needles are **cutting needles** with a traditional beveled tip. *Whitacre needle* - This is a **pencil-point, atraumatic needle** with a rounded tip and side opening. - Designed to separate rather than cut dural fibers, reducing post-dural puncture headache risk. *Sprotte needle* - Another **pencil-point, atraumatic needle** similar to Whitacre but with a larger side opening. - Also designed to minimize post-dural puncture headache. *Tuohy needle* - A **curved-tip needle** primarily used for **epidural anesthesia**, not lumbar puncture. - Features a Huber tip that helps guide the epidural catheter.

Q: A 60-year-old male presents to the emergency department on the second day of symptom onset with progressive deterioration of consciousness due to large right MCA territory infarct. Which of the following is the most appropriate management? (Image: img-179.jpeg)

Decompressive surgery. ***Decompressive surgery*** - A large **MCA territory infarct** causes significant brain edema, leading to increased **intracranial pressure** and progressive deterioration of consciousness, especially on day 2. - **Decompressive craniectomy** is often necessary in such cases to reduce pressure, prevent herniation, and improve outcomes by removing a portion of the skull. *Anticoagulation* - Anticoagulation is primarily used for preventing future thrombotic events due to conditions like **atrial fibrillation**, or for managing an evolving stroke if there's no major hemorrhage risk. - In the setting of a **large ischemic stroke** with significant edema and risk of hemorrhagic transformation, anticoagulation can increase the risk of bleeding into the infarct. *Dual antiplatelet therapy* - **Dual antiplatelet therapy** (DAPT) is typically used to prevent recurrent ischemic events following a **minor stroke** or **transient ischemic attack (TIA)**. - It is not indicated for managing acutely deteriorating consciousness due to brain edema in a **large established infarct**. *Mechanical thrombectomy* - **Mechanical thrombectomy** is an acute intervention performed within a narrow time window (typically up to 24 hours in select patients, but ideally much earlier) to remove the clot and **restore blood flow**. - On the second day of symptom onset, with a fully developed **large infarct** and progressive neurological deterioration due to edema, the brain tissue is likely already irreversibly damaged, making thrombectomy ineffective and potentially harmful due to reperfusion injury.

Q: Identify the instrument shown in the figure below.

Quincke's needle. ***Quincke's needle*** - A **Quincke's needle** is a spinal needle with a **sharp, beveled cutting tip** designed for lumbar punctures and cerebrospinal fluid access. - The cutting edge creates a clean penetration through the **dura mater** but may cause **post-dural puncture headache** due to larger dural tears compared to pencil-point needles. *Abraham's needle* - An **Abraham's needle** is a specialized **pleural biopsy needle** with a cutting mechanism designed to obtain pleural tissue samples. - Features a **notched cutting edge** and **outer cannula system** that differs significantly from the simple beveled design of spinal needles. *Liver biopsy needle* - **Liver biopsy needles** (such as Menghini or Jamshidi types) have **blunt or slightly beveled tips** designed to core tissue samples. - They typically feature **depth markings** and a **larger bore** for tissue acquisition, unlike the thin profile of spinal needles. *Bone marrow aspiration needle* - **Bone marrow needles** have a **trocar-style tip** designed to penetrate cortical bone and access marrow cavity. - Feature **depth guards**, **T-shaped handles**, and **larger gauge** construction for bone penetration, distinct from the delicate design of spinal needles.

Q: Which needle is shown below?

Vim-Silverman needle. ***Vim-Silverman needle*** - The image displays a needle with two prongs at the tip, which is characteristic of the **Vim-Silverman needle** used for **biopsy**. - This design allows for the capture of a tissue core between the prongs for microscopic examination. *Tru-cut needle* - A Tru-cut needle is also a biopsy needle, but it typically has a **single, cutting cannula** with a notch in its inner stylet. - Its design is different from the dual-pronged tip shown in the image. *Lumbar puncture needle* - A **lumbar puncture needle** (spinal needle) is used to access the subarachnoid space for cerebrospinal fluid (CSF) collection or drug administration. - It usually has a single, sharp bevel and a stylet, but lacks the biopsy collecting mechanism seen in the image. *Abraham's pleural biopsy needle* - **Abraham's pleural biopsy needle** is specifically designed for pleural biopsies and typically has a hook or a cutting edge that can be closed to obtain a tissue sample. - Its structure differs significantly from the bifurcated tip shown in the image.

Q: Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - The **Limberg procedure** (rhomboid flap) and **Karydakis flap** are the most widely established plastic surgical techniques used to close the defect after pilonidal sinus excision. - These techniques aim to **flatten the natal cleft** and move the scar away from the midline, reducing tension and recurrence rates. - **Y-V plasty** is less commonly used specifically for pilonidal sinus compared to Limberg and Karydakis procedures, though it can be employed for tissue advancement in selected cases. - This combination excludes Z-plasty, which is not a primary technique for pilonidal sinus closure. *II, III and IV* - While **Karydakis procedure** is indeed a standard technique, this option incorrectly includes **Z-plasty**, which is generally used for **scar revision** or releasing contractures rather than primary closure of large excisional defects. - It also excludes the **Limberg flap**, which is one of the most commonly used techniques worldwide for pilonidal sinus surgery. *I, III and IV* - This option incorrectly includes **Z-plasty** while excluding **Y-V plasty**. - Z-plasty is not a primary technique for closing pilonidal sinus defects as it doesn't provide adequate tissue coverage for large excisions. - The **Limberg and Karydakis procedures** are the mainstay techniques from this list. *I, II and III* - This combination incorrectly includes **Z-plasty** as a primary technique for closing the excisional defect. - It omits the **Karydakis procedure**, which is one of the most widely recognized and effective flaps for pilonidal disease with excellent outcomes. - The Karydakis flap specifically focuses on **modifying the natal cleft contour** and displacing the incision laterally for better healing and lower recurrence rates.

Q: Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :

I, II and III. ***I, II and III*** - **I. Barbed sutures** have unidirectional or bidirectional barbs that grip tissue, negating the need for traditional knots to secure the suture line. This property can significantly **reduce operating time** and the volume of foreign material left in the wound. - **II. Vertical mattress sutures** are designed to achieve precise wound edge approximation and eversion, which are crucial for optimal healing and cosmesis, particularly in areas under tension or for thick skin. - **III. The Aberdeen knot** is a slip knot technique specifically designed to secure the end of a **continuous suture line** efficiently and reliably. It provides a flat, secure knot that minimizes bulk and is less prone to loosening. *I, II and IV* - While statements I and II are correct, statement IV is incorrect. **Silk is a braided, non-absorbable multifilament suture** that can cause significant tissue reaction. - It is generally not preferred for subcuticular suturing due to its increased risk of infection, visibility, and foreign body reaction compared to monofilament, absorbable sutures. *II, III and IV* - Statements II and III are correct, but statement IV is incorrect. **Silk is avoided for subcuticular closure** due to its inflammatory properties and potential for suture extrusion or sinus formation. - Subcuticular sutures typically use **absorbable monofilament sutures** (e.g., poliglecaprone 25 or polydioxanone) to minimize tissue reaction and achieve good cosmetic results. *I, III and IV* - Statements I and III are correct regarding barbed sutures and the Aberdeen knot, respectively. However, statement IV is incorrect because **silk suture is a non-absorbable, braided material that is highly reactive and not suitable for subcuticular placement**, where monofilament absorbable sutures are preferred for minimal tissue reaction and good cosmesis.

Q: A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

WHO surgical safety checklist. **WHO surgical safety checklist** - The questions about patient identity, procedure site, and anticipated critical events are key components of the **"Sign In"** and **"Time Out"** sections of the **WHO Surgical Safety Checklist**. - This checklist is designed to improve **patient safety** by ensuring communication and adherence to essential steps before, during, and after surgery, thereby reducing surgical errors. *nurses safety checklist* - While nurses play a crucial role in patient safety, there isn't a universally recognized "nurses safety checklist" that specifically encompasses these exact comprehensive surgical verification steps. - The comprehensive framework described, with its specific questions, aligns more closely with the broader, interdisciplinary **WHO Surgical Safety Checklist**. *universal precautions checklist* - **Universal precautions** focus on preventing the transmission of bloodborne pathogens and other infectious agents by treating all bodily fluids as potentially infectious. - This checklist primarily addresses **infection control** measures and does not cover patient identification, surgical site verification, or critical event anticipation. *MCI patient safety checklist* - A "MCI patient safety checklist" is not a widely recognized or standardized medical safety protocol. - The scenario describes a standard, internationally adopted set of safety checks specifically for surgical procedures, which is the **WHO Surgical Safety Checklist**.

Q: Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?

Radical hysterectomy. ***Radical hysterectomy*** - This procedure involves extensive dissection around the cervix and upper vagina, increasing the risk of **damage to the paracervical nerve plexus** (Frankenhäuser's plexus). - Damage to this autonomic plexus, which supplies the bladder, can lead to **atonicity** and urinary retention postoperatively due to disrupted innervation. *Simple hysterectomy* - A simple hysterectomy removes the uterus but preserves the parametrial tissues and hence the **paracervical nerve plexus**, minimizing the risk of bladder denervation. - While temporary bladder dysfunction can occur due to local trauma, long-term atonicity is less likely compared to radical procedures. *Myomectomy* - Myomectomy involves the surgical removal of uterine fibroids (myomas) while **preserving the uterus**. - This procedure generally involves minimal dissection in the vicinity of the paracervical nerve plexus, making bladder atonicity an uncommon complication. *Vaginal hysterectomy* - A vaginal hysterectomy removes the uterus through the vagina, with dissection primarily involving the uterosacral and cardinal ligaments. - Although there is some manipulation near the plexus, the **extent of dissection is typically less** than a radical hysterectomy, leading to a lower risk of complete denervation and atonicity.

Question 1

A surgical suture material is shown in the image below. Which of the following statements is TRUE about this suture?

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

Derived from catgut

Answer

Non-absorbable

Answer

Absorbed over 3 months

Question 2

The patient has developed a hernia at the site highlighted by red circle. What is this hernia called as per NYHUS classification? (NEET Pattern 2018)

Accepted Answer

Nyhus Type IIIB

Answer

Nyhus Type I

Answer

Nyhus Type II

Answer

Nyhus Type IIIA

Question 3

Identify the instrument shown in the image, which is a lumbar puncture needle with a sharp cutting edge and a hub indicating CSF.

Accepted Answer

Quincke's needle

Answer

Whitacre needle

Answer

Sprotte needle

Answer

Tuohy needle

Question 4

A 60-year-old male presents to the emergency department on the second day of symptom onset with progressive deterioration of consciousness due to large right MCA territory infarct. Which of the following is the most appropriate management? (Image: img-179.jpeg)

Accepted Answer

Decompressive surgery

Answer

Anticoagulation

Answer

Dual antiplatelet therapy

Answer

Mechanical thrombectomy

Question 5

Identify the instrument shown in the figure below.

Accepted Answer

Quincke's needle

Answer

Abraham's needle

Answer

Liver biopsy needle

Answer

Bone marrow aspiration needle

Question 6

Which needle is shown below?

Accepted Answer

Vim-Silverman needle

Answer

Tru-cut needle

Answer

Lumbar puncture needle

Answer

Abraham's pleural biopsy needle

Question 7

Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound?
I. Limberg procedure
II. Y-V plasty
III. Z-plasty
IV. Karydakis procedure

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 8

Which of the following statements are correct regarding sutures in surgery?
I. Barbed sutures have the advantage of eliminating the need for knots.
II. Vertical mattress sutures help in eversion of wound edges.
III. Aberdeen knot is used for continuous suturing.
IV. Silk is preferred for subcuticular suturing.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 9

A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

Accepted Answer

WHO surgical safety checklist

Answer

nurses safety checklist

Answer

universal precautions checklist

Answer

MCI patient safety checklist

Question 10

Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?

Accepted Answer

Radical hysterectomy

Answer

Simple hysterectomy

Answer

Myomectomy

Answer

Vaginal hysterectomy

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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