General Surgery Principles Practice Questions

Q: Which of the following is a non-self-retaining handheld retractor?

Davis retractor. ***Davis Retractor*** - The **Davis retractor** is a **handheld retractor** primarily used in procedures like tonsillectomy to retract the tongue and soft palate, and requires continuous manual holding. - It does not have a locking mechanism or self-retaining features, distinguishing it from retractors designed to stay in place once positioned. *Mollison's mastoid retractor* - The **Mollison's mastoid retractor** is a **self-retaining retractor** commonly used in mastoid surgery. - It features ratcheted arms that lock into position, allowing it to hold tissue apart without continuous manual assistance. *Jansen's mastoid retractor* - The **Jansen's mastoid retractor** is another **self-retaining retractor** with a spring-loaded or ratcheted mechanism. - This design allows it to maintain tissue retraction in mastoid and ear surgeries without requiring a surgeon's constant hold. *Lempert's endaural retractor* - The **Lempert's endaural retractor** is a **self-retaining retractor** specifically designed for endaural approaches to the middle ear. - Its design includes sharp prongs and a flexible but stable frame that anchors in tissue, providing continuous retraction.

Q: All these are techniques to decrease scarring except:

Late removal of sutures. ***Late removal of sutures*** - **Late removal of sutures** can lead to permanent suture marks and increased scarring, as the epithelial cells grow down the suture track. - This increases the foreign body reaction and the duration of inflammation, ultimately worsening the cosmetic outcome. *Tension-free suturing* - **Tension-free suturing** minimizes mechanical stress on the wound edges, which is crucial for optimal healing and reduced scar formation. - Reduced tension prevents excessive inflammation and tissue ischemia, leading to a flatter, less noticeable scar. *Finer suture materials* - Using **finer suture materials** reduces the amount of foreign body reaction, which is a key factor in scar formation. - Smaller caliber sutures cause less tissue trauma and inflammation, resulting in a more aesthetically pleasing scar. *Debridement* - **Debridement** removes necrotic tissue, foreign bodies, and devitalized tissue from the wound, which are sources of chronic inflammation and impaired healing. - By creating a clean wound bed, debridement promotes healthy granulation tissue and reduces the risk of excessive scarring.

Q: Wound healing is delayed by all of the following EXCEPT?

Debridement. ***Debridement*** - **Debridement** is the medical removal of **dead, damaged, or infected tissue** to improve the healing potential of the remaining healthy tissue. - By removing impediments to healing, debridement actually **facilitates wound healing**, rather than delaying it. *Presence of foreign bodies* - The presence of **foreign bodies** (e.g., dirt, glass, sutures that are causing a reaction) in a wound can act as a **persistent irritant**, leading to chronic inflammation. - This ongoing inflammatory response can **impair the normal progression of wound healing**, often prolonging the healing process. *Trauma* - Severe or repeated **trauma** to a healing wound can disrupt the delicate new tissue formation, such as **granulation tissue** and **epithelium**. - This disruption can lead to **re-injury**, increased inflammation, and a significant delay in the wound's progression through its healing phases. *Excessive tissue manipulation* - **Excessive tissue manipulation** during surgery or wound care can cause further damage to surrounding healthy tissues and blood vessels. - This can increase wound edema, create more dead space, and release inflammatory mediators, all of which can **impede the healing process**.

Q: The incision in which rectus abdominis muscle is cut transversely is :

Maylard. ***Maylard*** - The **Maylard incision** involves **transverse cutting** (transection) of the **rectus abdominis muscles** to provide excellent pelvic exposure. - This muscle transection allows for superior **lateral access** and is commonly used in **gynecological oncology** procedures. *Kerr* - The **Kerr incision** is a **muscle-splitting technique** where the rectus abdominis muscles are **separated along their fibers**, not cut transversely. - Commonly used for **lower segment Cesarean sections**, preserving muscle integrity while providing adequate access. *Pfannenstiel* - The **Pfannenstiel incision** involves a **transverse skin incision** but the rectus muscles are **retracted laterally** after the anterior sheath is opened, not cut. - The muscles remain intact and are simply **separated in the midline** and moved aside, preserving muscle function and strength. *All of the options* - This is incorrect because **only the Maylard incision** actually involves transverse cutting of the rectus abdominis muscles. - The other incisions either split the muscles along fibers (Kerr) or retract them laterally (Pfannenstiel) without transection.

Q: For a midline incision in the abdomen, length of suture required is:

4 times the length of incision. ***4 times the length of incision*** - The standard recommendation for interrupted abdominal fascial closure is to use a **suture-to-wound length ratio** of approximately **4:1**. - This ratio ensures sufficient material for adequate fascial apposition, overlapping bites, and knots, which are crucial for preventing wound dehiscence. *3 times the length of incision* - A 3:1 suture-to-wound ratio might be insufficient for secure fascial closure, potentially leading to increased tension on the suture lines and a **higher risk of dehiscence**. - This ratio could be considered for very specific continuous closure techniques, but it's generally not recommended for standard interrupted closures. *2 times the length of incision* - A 2:1 ratio is generally considered **inadequate** for most fascial closures, especially in the abdomen. - This ratio would likely result in insufficient suture material, leading to very large bites and an insecure closure, significantly increasing the risk of **wound dehiscence** and **herniation**. *5 times the length of incision* - While it ensures enough material, a 5:1 ratio suggests using **excessive suture material** which might extend operating time. - Using significantly more suture than necessary offers no proven benefit in terms of wound security and can sometimes introduce more foreign material into the wound.

Q: Venous air embolism during surgery is seen with

Sitting position. ***Sitting position*** - In the **sitting position** (e.g., for posterior fossa surgery), the surgical site is often above the level of the heart, creating a negative pressure gradient in the veins. - This **negative pressure** can draw air into opened veins if they are not adequately occluded, leading to a venous air embolism. *Lateral position* - While air embolism can occur in various positions if venous sinuses are open, the **lateral position** does not inherently create the same significant negative pressure gradient as the sitting position relative to the heart. - Risk is generally lower compared to positions where the surgical field is significantly elevated above the heart. *Supine position* - In the **supine position**, the surgical field is typically at or below heart level, which minimizes the likelihood of a negative pressure gradient in the veins. - This position is generally considered to have a **lower risk** for venous air embolism compared to upright positions. *Prone position* - The **prone position** can also increase central venous pressure if abdominal compression occurs, making venous air embolism less likely due to a positive venous pressure. - Although other surgical complications can arise, a venous air embolism is **not a classic risk** specifically associated with the prone position from a negative pressure standpoint.

Q: Whitehead's varnish in gauze is used to arrest bleeding from:

Bleeding from bone.. ***Bleeding from bone*** - **Whitehead's varnish** contains **iodoform and benzoin** (iodoform in benzoin compound tincture), which have an **astringent and antiseptic** effect. - When applied to bleeding bone surfaces, it helps to **coagulate proteins** and promote **mechanical tamponade**, thereby arresting bleeding. - Commonly used in **oral and maxillofacial surgery** to control bleeding from bone cavities. *Bleeding from capillaries* - Capillary bleeding is usually **minor and self-limiting**, often controlled by **direct pressure** or simple absorbents. - Whitehead's varnish is typically reserved for more persistent bleeding from bony surfaces, not superficial capillaries. *Bleeding from skin* - Skin bleeding generally responds well to **direct pressure, simple dressings**, or **topical coagulants** if needed. - Whitehead's varnish is not a primary therapeutic agent for cutaneous bleeding; its formulation is specifically aimed at managing bone bleeding. *All of the options* - While it might theoretically have some effect on other types of bleeding, its **primary and specifically indicated use** is for bleeding from bone. - Applying it to all forms of bleeding would be **ineffective** or **inappropriate** given more conventional and targeted treatments available for capillary and skin bleeding.

Q: Abdominal compartment syndrome is characterized by the following except:

Oliguria due to ureter obstruction. ***Oliguria due to ureter obstruction*** - **Oliguria** in abdominal compartment syndrome is primarily due to **renal hypoperfusion** caused by increased intra-abdominal pressure compressing renal vasculature and reducing kidney blood flow, **not ureter obstruction**. - Increased intra-abdominal pressure can also cause direct **renal parenchymal compression** and activation of neurohormonal mechanisms, leading to reduced urine output. *Hypotension due to decrease in venous return* - Increased intra-abdominal pressure compresses the **inferior vena cava**, leading to reduced **venous return** to the heart. - This decreased preload results in a lower cardiac output and subsequent **hypotension**. - This is a **true characteristic** of abdominal compartment syndrome. *Hypoxia due to increased peak inspiratory pressure* - Elevated intra-abdominal pressure pushes the diaphragm upwards, leading to reduced **lung compliance** and **tidal volume**. - This increases the **peak inspiratory pressure** required to ventilate the lungs and can result in **hypoxia**. - This is a **true characteristic** of abdominal compartment syndrome. *Hypercarbia and respiratory acidosis* - The combination of **diaphragmatic splinting** and **reduced lung compliance** leads to impaired ventilation. - This causes inadequate carbon dioxide excretion, resulting in **hypercarbia** (elevated CO2) and subsequent **respiratory acidosis**. - This is a **true characteristic** of abdominal compartment syndrome.

Question 1

Which of the following is a non-self-retaining handheld retractor?

Accepted Answer

Davis retractor

Answer

Mollison's mastoid retractor

Answer

Jansen's mastoid retractor

Answer

Lempert's endaural retractor

Question 2

All these are techniques to decrease scarring except:

Accepted Answer

Late removal of sutures

Answer

Tension-free suturing

Answer

Finer suture materials

Answer

Debridement

Question 3

Wound healing is delayed by all of the following EXCEPT?

Accepted Answer

Debridement

Answer

Presence of foreign bodies

Answer

Trauma

Answer

Excessive tissue manipulation

Question 4

To minimize ureteric damage, the following preoperative and operative precautions may be taken except:

Accepted Answer

Cystoscopy

Answer

Ureter should not be dissected off the peritoneum for a long distance

Answer

Bladder should be pushed downwards and outwards while the clamps are placed near the angles of vagina

Answer

Direct visualization during surgery

Question 5

What is the advantage of fiberoptic bronchoscopy over rigid bronchoscopy?

Accepted Answer

Good view

Answer

Better airway control

Answer

Foreign body removal

Answer

In a sick child, it can be passed through an endotracheal tube

Question 6

The incision in which rectus abdominis muscle is cut transversely is :

Accepted Answer

Maylard

Answer

Kerr

Answer

Pfannenstiel

Answer

All of the options

Question 7

For a midline incision in the abdomen, length of suture required is:

Accepted Answer

4 times the length of incision

Answer

3 times the length of incision

Answer

2 times the length of incision

Answer

5 times the length of incision

Question 8

Venous air embolism during surgery is seen with

Accepted Answer

Sitting position

Answer

Lateral position

Answer

Supine position

Answer

Prone position

Question 9

Whitehead's varnish in gauze is used to arrest bleeding from:

Accepted Answer

Bleeding from bone.

Answer

Bleeding from capillaries.

Answer

Bleeding from skin.

Answer

All of the options.

Question 10

Abdominal compartment syndrome is characterized by the following except:

Accepted Answer

Oliguria due to ureter obstruction

Answer

Hypotension due to decrease in venous return

Answer

Hypoxia due to increased peak inspiratory pressure

Answer

Hypercarbia and respiratory acidosis

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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