General Surgery Principles — MCQs

General Surgery Principles Indian Medical PG Practice Questions and MCQs

Question 811: Tidy wounds inflicted by sharp instruments and containing no devitalised tissues are expected to heal by

A. Primary healing (Correct Answer)
B. Skin grafting
C. Secondary healing
D. Formation of contracture

Explanation: ***Primary healing*** - This mode of healing occurs in **clean, surgically incised, or sharply cut wounds** with minimal tissue loss and edges that can be approximated. - Features include minimal scarring and rapid re-epithelialization without granulation tissue formation. *Skin grafting* - This is a surgical procedure used to cover large wounds where **primary closure is not possible** or to repair areas with significant tissue loss. - It involves transplanting skin from one area of the body to another, not a natural healing process for tidy wounds. *Secondary healing* - This occurs in wounds with **significant tissue loss, infection, or edges that cannot be approximated**, requiring the formation of granulation tissue to fill the defect. - It results in a larger scar and takes longer to heal compared to primary healing. *Formation of contracture* - **Wound contracture** is a process that occurs during secondary healing, where myofibroblasts pull the wound edges together, leading to a reduction in wound size. - While it's a part of the healing process for certain wounds, it is not the primary mode of healing for tidy, sharp wounds and can lead to functional impairment if severe.

Question 812: A 35 year old male patient comes to casualty with acute pain abdomen; and on examination found to have cold, clammy extremities, sunken eyes, dry tongue, thready pulse, drawn and anxious face with abdominal guarding and rigidity. This clinical picture indicates:

A. Acute cholecystitis
B. Local peritonitis
C. Diffuse late peritonitis (Correct Answer)
D. Diffuse early peritonitis

Explanation: ***Diffuse late peritonitis*** - The combination of **cold, clammy extremities**, **thready pulse**, **sunken eyes**, **dry tongue**, and an **anxious face** points to significant **systemic inflammatory response syndrome (SIRS)** and **hypovolemic shock**, which are characteristic of late-stage peritonitis. - **Abdominal guarding and rigidity** indicate widespread peritoneal irritation, and the systemic signs confirm that this is a late-stage, diffuse process, rather than localized or early. *Acute cholecystitis* - While it causes **acute pain in the abdomen**, it is typically localized to the **right upper quadrant** and does not usually present with the severe systemic signs of **shock** described (e.g., cold extremities, thready pulse) unless complications like perforation have occurred. - The generalized abdominal guarding and rigidity suggest a more diffuse inflammatory process beyond a single inflamed organ. *Local peritonitis* - This condition involves inflammation of a specific area of the peritoneum, leading to **localized tenderness**, guarding, and rebound tenderness, but typically **without the widespread systemic signs of shock and severe hypovolemia** seen in this patient. - The description of a "drawn and anxious face" and global signs of shock indicate a more widespread, serious condition. *Diffuse early peritonitis* - **Early diffuse peritonitis** would present with generalized abdominal pain, guarding, and rigidity, but the severe systemic signs of **shock** (e.g., cold, clammy extremities, thready pulse, sunken eyes) are usually not as pronounced or absent. - The patient's presentation with **profound signs of hypovolemia and systemic compromise** indicates a more advanced, "late" stage of the disease where fluid shifts and septic shock are already established.

Question 813: During laparoscopic inguinal hernia repair, in the ‘triangle of doom’, the following are true EXCEPT:

A. Vas deferens on medial side
B. Base by iliac vessels
C. Cord structures on lateral side (Correct Answer)
D. Dangerous area for dissection

Explanation: ***Cord structures on lateral side*** - This statement is somewhat **ambiguous** and is considered the EXCEPT answer in this context. - The **spermatic cord** contains multiple structures, and different components form **both boundaries** of the triangle of doom: - The **vas deferens** (a cord structure) forms the **medial** boundary - The **gonadal vessels** (testicular artery and pampiniform plexus, also cord structures) form the **lateral** boundary - In the context of this question, "cord structures" likely refers to the **bulk of the cord or vas deferens**, which is positioned **medially**, making the lateral positioning statement incorrect as commonly taught. *Vas deferens on medial side* - The **vas deferens** forms the **medial border** of the triangle of doom. - This is a key anatomical landmark used to identify the triangle during laparoscopic inguinal hernia repair. *Base by iliac vessels* - The **external iliac artery and vein** form the **base (inferior border)** of the triangle of doom. - These are the most dangerous structures in this region—injury can lead to catastrophic hemorrhage. *Dangerous area for dissection* - The triangle of doom is aptly named because it contains **critical vascular structures** including the **external iliac vessels** and **deep circumflex iliac artery**. - **Aggressive dissection, stapling, or tack placement** in this area can cause life-threatening vascular injury or damage to the **femoral branch of the genitofemoral nerve**.

Question 814: A 40 year old man, with a history of a reducible left groin swelling of two years, comes with severe pain over left groin. The swelling is now non-reducible and is very tender to touch. The most probable treatment plan for this patient would be:

A. Hot fomentation of groin area
B. Oral antibiotics
C. Continue conservative management
D. Prepare for emergency surgery (Correct Answer)

Explanation: ***Prepare for emergency surgery*** - The sudden onset of **severe pain**, non-reducibility, and tenderness in a pre-existing reducible groin swelling strongly suggests **incarceration** or **strangulation** of a hernia. - **Strangulation** is a surgical emergency due to the risk of **ischemic bowel injury**, requiring immediate surgical intervention. *Hot fomentation of groin area* - This offers no therapeutic benefit for an incarcerated or strangulated hernia and may delay necessary surgical intervention, leading to **worse patient outcomes**. - It would be inappropriate for a condition that poses a risk of **bowel necrosis**. *Oral antibiotics* - While infection could be a secondary complication of bowel necrosis, antibiotics alone will not resolve the mechanical obstruction or relieve the **ischemia**. - They do not address the primary problem of **hernia incarceration** or strangulation. *Continue conservative management* - Conservative management is suitable for **reducible hernias** that are asymptomatic or mildly symptomatic, but not for acute, painful, and non-reducible hernias. - Continuing conservative management in this setting would lead to **bowel strangulation** and potential **peritonitis** or sepsis.

Question 815: In Hernia repair, polypropylene suture is used because

A. It is a synthetic monofilament non-absorbable suture with low tissue reaction and high tensile strength (Correct Answer)
B. It is a synthetic monofilament undyed absorbable suture with high tissue reaction and low tensile strength
C. It is a synthetic monofilament undyed non absorbable suture with high tissue reaction and which degrades at 15-20% per year
D. It is a synthetic braided dyed absorbable suture with low tissue reaction and high tensile strength

Explanation: ***It is a synthetic monofilament non-absorbable suture with low tissue reaction and high tensile strength*** - **Polypropylene** is the preferred suture material in hernia repair due to its **high tensile strength** and ability to maintain knot security long-term - Its **monofilament** structure minimizes the risk of bacterial colonization compared to braided sutures - **Low tissue reactivity** reduces inflammation and infection risk, crucial for successful hernia repair - Being **non-absorbable**, it provides permanent support to the repaired tissue *It is a synthetic monofilament undyed absorbable suture with high tissue reaction and low tensile strength* - This is incorrect because polypropylene is **non-absorbable**, meaning it retains its strength over time rather than degrading - Polypropylene has **low tissue reaction**, not high, and possesses **high tensile strength**, not low *It is a synthetic monofilament undyed non absorbable suture with high tissue reaction and which degrades at 15-20% per year* - While polypropylene is synthetic, monofilament, and non-absorbable, it has **low tissue reaction**, not high - Polypropylene shows minimal degradation (less than 1% annually), not 15-20% per year - This excellent retention of tensile strength is why it's preferred for hernia repair *It is a synthetic braided dyed absorbable suture with low tissue reaction and high tensile strength* - This is incorrect as polypropylene is **monofilament**, not braided - The monofilament structure reduces bacterial adherence compared to braided sutures - It is **non-absorbable**, not absorbable, providing permanent structural support

Question 816: Paralytic ileus is a type of:

A. Inflammatory obstruction
B. Drug induced obstruction
C. Adynamic obstruction (Correct Answer)
D. Dynamic obstruction

Explanation: ***Adynamic obstruction*** - **Paralytic ileus** is characterized by the absence of normal peristaltic movement of the bowel, leading to a functional or **adynamic obstruction** without a physical blockage. - This condition often results from factors like **abdominal surgery**, electrolyte imbalances, or certain medications, which disrupt neural control over intestinal motility. *Inflammatory obstruction* - An **inflammatory obstruction** implies a physical blockage or narrowing of the bowel lumen due to inflammation, such as in **Crohn's disease** or diverticulitis. - While inflammation can contribute to ileus, the primary mechanism of paralytic ileus is a lack of motility, not a physical inflammatory mass blocking the lumen. *Drug-induced obstruction* - While certain drugs, such as **opioids** or **anticholinergics**, can *cause* paralytic ileus by reducing gut motility, the term "drug-induced obstruction" is typically used when the drug directly creates a physical obstruction. - In the context of ileus, drugs induce a *functional* impairment rather than a physical **luminal blockage**. *Dynamic obstruction* - **Dynamic obstruction** refers to a *physical blockage* of the bowel, such as a **volvulus**, **intussusception**, or an **hernia**, where the bowel is actively trying to overcome the obstruction (hence "dynamic"). - In contrast, paralytic ileus involves a *lack* of active bowel movement, classifying it as an adynamic, rather than dynamic, obstruction.

Question 817: Which one of the following regarding absorbable meshes is NOT true?

A. They show very good results as collagen deposition is maximum (Correct Answer)
B. They are made of polyglycolic acid fibre
C. They are used to buttress sutured repair
D. They are used in temporary abdominal wall closure

Explanation: ***They show very good results as collagen deposition is maximum*** - Absorbable meshes are **resorbed by the body** over time, leading to less collagen deposition compared to non-absorbable meshes, which provide a permanent scaffold for tissue integration. - While they can be useful in certain situations, the statement implies **superior results due to maximum collagen deposition**, which is contradictory to their nature and purpose in situations where permanent reinforcement is needed. *They are made of polyglycolic acid fibre* - Many absorbable meshes, such as **Dexon** and **Vicryl**, are indeed made from synthetic polymers like **polyglycolic acid (PGA)** or polylactic acid (PLA). - These materials are designed to be **hydrolyzed and absorbed** by the body. *They are used to buttress sutured repair* - Absorbable meshes can be used to **reinforce a primary suture line** in contaminated fields or when there is concern for tissue breakdown. - They provide **temporary support** while the native tissue heals. *They are used in temporary abdominal wall closure* - In cases of **abdominal compartment syndrome** or severe contamination, absorbable meshes may be used for **temporary closure** of the abdominal wall. - This allows for staged repair and reduces the risk of infection often associated with permanent meshes in these scenarios.

Question 818: Which of the following are types of wound healing? 1. Primary Intention 2. Secondary Intention 3. Tertiary Intention 4. Quaternary Intention

A. 1, 2 and 4
B. 1, 2 and 3 (Correct Answer)
C. 2, 3 and 4
D. 1, 3 and 4

Explanation: ***1, 2 and 3*** - These options correctly identify the three recognized types of **wound healing** in surgical practice. - **Primary intention (healing by first intention)**: Clean wounds with approximated edges, minimal tissue loss, heals with minimal scarring (e.g., surgical incisions). - **Secondary intention (healing by second intention)**: Wounds with significant tissue loss that heal by granulation tissue formation, wound contraction, and epithelialization (e.g., pressure ulcers, large traumatic wounds). - **Tertiary intention (delayed primary closure)**: Contaminated wounds initially left open for 3-5 days, then closed after infection risk decreases. *1, 2 and 4* - This option incorrectly includes **"Quaternary Intention,"** which is **not a recognized classification** in wound healing. - Only primary, secondary, and tertiary intention are standard types described in surgical textbooks. *2, 3 and 4* - This option omits **"Primary Intention,"** the most common type of wound healing for clean surgical incisions. - It also incorrectly includes "Quaternary Intention," which does not exist in wound healing classification. *1, 3 and 4* - This option omits **"Secondary Intention,"** a crucial healing process for wounds with substantial tissue loss that cannot be primarily closed. - "Quaternary Intention" is not a valid wound healing type and represents a distractor in this question.

Question 819: The following nerves are blocked for repairing inguinal hernia by local anaesthetic except:

A. Ilio-inguinal
B. Femoral (Correct Answer)
C. Genito-femoral
D. Ilio-hypogastric

Explanation: ***Femoral*** - The **femoral nerve** primarily innervates the anterior thigh muscles and provides sensory supply to the anterior thigh and medial leg; its block is not typically required for **inguinal hernia repair**. - Blocking the femoral nerve would primarily affect **motor function** of the quadriceps and sensation in the distribution of the saphenous nerve, which is not the surgical field for an inguinal hernia. *Ilio-inguinal* - The **ilio-inguinal nerve** provides sensation to the inguinal region, scrotum/labia majora, and the medial aspect of the thigh, making its block essential for anesthesia during **inguinal hernia repair**. - It lies in the **inguinal canal** and is typically targeted with local anesthetic to cover the incision site and surgical area. *Genito femoral* - The **genitofemoral nerve** has both genital and femoral branches, providing sensation to the scrotum/labia majora and a small area of the femoral triangle, respectively, and is therefore often included in an **inguinal block**. - Its blockade helps to cover the sensory innervation of the **spermatic cord** and a portion of the inguinal region, contributing to effective pain control. *Ilio-hypogastric* - The **ilio-hypogastric nerve** provides sensory innervation to the suprapubic and gluteal regions, and its blockade is important for covering the **upper part of the surgical incision** for an inguinal hernia repair. - It runs parallel to the ilio-inguinal nerve and is often blocked concurrently to ensure **comprehensive analgesia** of the abdominal wall.

Question 820: Which of the following suture materials has the least tissue reaction?

A. Silk
B. Cotton / Linen
C. Chromic catgut
D. Stainless steel (Correct Answer)

Explanation: ***Stainless steel*** - **Stainless steel** is a **monofilament** suture with the **lowest tissue reactivity** due to its inert nature. - It is often used in situations requiring maximal strength and minimal biological interaction, such as abdominal wall closure or orthopedic procedures. *Silk* - **Silk** is a **multifilament, natural, non-absorbable** suture and is known for its **moderate tissue reactivity** due to its braided structure and organic origin. - While it provides good knot security, its reactivity makes it unsuitable for areas where minimal foreign body reaction is paramount. *Cotton / Linen* - **Cotton and linen** sutures are **natural, multifilament, non-absorbable** materials that exhibit significant **tissue reactivity**. - Their fibrous nature can lead to considerable inflammatory response and are rarely used in modern surgical practice. *Chromic catgut* - **Chromic catgut** is a **natural, absorbable** suture treated with chromium salts to prolong its absorption time, but it still triggers a **significant inflammatory response** as it is absorbed by enzymatic digestion. - Its high tissue reactivity makes it less ideal for situations requiring minimal foreign body reaction compared to synthetic or metallic sutures.

Practice by Chapter

Wound Healing and Care

Practice Questions

Surgical Infections

Practice Questions

Fluid and Electrolyte Management

Practice Questions

Nutrition in Surgical Patients

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Hemostasis and Blood Transfusion

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Surgical Instruments and Equipment

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Sutures and Stapling Devices

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Minimal Access Surgery Principles

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Surgical Complications

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Anesthesia Principles for Surgeons

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Surgical Oncology Principles

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Evidence-Based Surgery

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