General Surgery Principles Practice Questions

Q: Tarsometatarsal amputation is also known as?

Lisfranc amputation. ***Lisfranc amputation*** - This amputation is performed through the **tarsometatarsal joints**, detaching the forefoot from the midfoot. - It is named after **Jacques Lisfranc de St. Martin**, a French surgeon who described the disarticulation. *Pirogoff amputation* - This is an ankle disarticulation with preservation of the posterior part of the **calcaneus**, which is then fused with the tibia. - Its goal is to create an end-weight-bearing stump by providing a longer lever arm. *Symes amputation* - This involves disarticulation at the **ankle joint**, removing the entire foot but preserving the heel fat pad to create an end-weight-bearing stump. - It is distinct from a tarso-metatarsal amputation as it is performed at a more proximal level. *Chopart's amputation* - This is a midtarsal disarticulation through the **talonavicular** and **calcaneocuboid joints**, preserving the talus and calcaneus. - It involves removing the forefoot and part of the midfoot, thus being more proximal than a Lisfranc amputation.

Q: In a female with appendicitis in pregnancy the treatment of choice is:

Surgery at earliest. ***Surgery at earliest*** - **Prompt surgical intervention** is crucial for appendicitis in pregnancy to prevent complications such as perforation, peritonitis, and maternal or fetal morbidity and mortality. - Delaying surgery increases the risk of rupture, which can be devastating for both the mother and the fetus. *Continue pregnancy with medical Rx* - **Medical management (antibiotics alone)** is generally ineffective for acute appendicitis in pregnant women and carries a high risk of progression to perforation. - This approach would expose the mother and fetus to serious complications, including sepsis and preterm labor, without addressing the underlying surgical pathology. *Surgery after delivery* - Delaying surgery until after delivery is unsafe and potentially fatal, as **appendiceal rupture could occur at any time** during pregnancy. - The risk of **perforation, peritonitis, and subsequent complications** is too high to justify waiting. *Abortion with appendectomy* - **Therapeutic abortion** is not indicated for uncomplicated appendicitis in pregnancy and does not improve the maternal prognosis for the appendicitis itself. - The focus is on treating the underlying medical condition (appendicitis) while preserving the pregnancy, if possible.

Q: Bedsore is an example of:

Trophic ulcer. ***Trophic ulcer*** - A **bedsore**, also known as a **decubitus ulcer**, is a classic example of a **trophic ulcer** because it results from impaired nutrition and blood supply to the tissues due to prolonged pressure. - **Trophic ulcers** generally arise from a disrupted nerve supply, prolonged pressure, or inadequate circulation, leading to tissue breakdown and poor healing. *Venous ulcer* - **Venous ulcers** are caused by venous insufficiency, where blood pools in the veins, leading to increased pressure and tissue damage, typically found in the lower legs. - They are characterized by **brawny edema**, hyperpigmentation, and usually appear irregular with a shallow base. *Post thrombotic ulcer* - A **post-thrombotic ulcer** is a specific type of venous ulcer that develops following a **deep vein thrombosis (DVT)**, damaging the venous valves and leading to chronic venous insufficiency. - It presents with symptoms similar to other venous ulcers but has a clear history of DVT as a predisposing factor. *Tropical ulcer* - **Tropical ulcers** are typically found in tropical and subtropical regions and are caused by a combination of minor trauma and bacterial infection (often **Fusobacterium species** and **Treponema pallidum pertenue**). - They are characterized by rapid onset, a painful, foul-smelling appearance, and often result in significant tissue destruction.

Q: Polyglactin 910 suture material ("Vicryl") is a / an

Absorbable synthetic suture. ***Absorbable synthetic suture*** - **Polyglactin 910**, marketed as **Vicryl**, is a **synthetic copolymer** of glycolide and lactide that undergoes hydrolysis in the body. - This hydrolysis leads to its eventual reabsorption over 56-70 days, classifying it as an **absorbable** material. - Vicryl maintains tensile strength for approximately 21 days before being fully absorbed. *Absorbable natural suture* - Natural absorbable sutures, such as **catgut** (plain and chromic), are derived from animal tissues and are absorbed enzymatically within the body. - **Polyglactin 910** is **synthetic**, not natural, despite being absorbable. *Non-absorbable synthetic suture* - Non-absorbable synthetic sutures (e.g., **nylon**, **polypropylene**, **polyester**) retain their tensile strength and remain in the body indefinitely or require removal. - Vicryl is designed to be **absorbed** over time through hydrolysis, distinguishing it from non-absorbable types. *Non-absorbable natural suture* - Examples of non-absorbable natural sutures include **silk** and **cotton**, which are derived from natural sources and are not reabsorbed by the body. - Polyglactin 910 is both **synthetic** and **absorbable**, making this option incorrect.

Q: A tracheostomised patient, with Portex tracheostomy tube, in the ward, developed sudden complete blockage of the tube. Which of the following is the best next step in the management -

Immediate removal of the tracheostomy tube. ***Immediate removal of the tracheostomy tube*** - In cases of **sudden complete tracheostomy tube blockage**, the primary concern is airway patency. Removing the tube is the quickest way to re-establish an airway, as the **tracheostomy stoma** will likely provide a path for breathing. - Delaying removal for suctioning or other interventions can lead to **critical hypoxia** and respiratory arrest if the blockage is total. *Suction of tube with saline* - While suctioning is a routine part of tracheostomy care, using saline to clear a **completely blocked tube** is unlikely to be effective and will delay definitive airway management. - The blockage, if complete and sudden, suggests a solid or highly viscous obstruction that saline alone cannot quickly resolve, potentially worsening the situation by pushing the obstruction deeper. *Suction of tube with sodium bicarbonate* - Sodium bicarbonate can be used for mucolytic purposes in some respiratory conditions, but it is not an immediate solution for a **sudden complete airway obstruction**. - Its action is too slow, and attempting to instill it into a completely blocked tube not only wastes critical time but would also be ineffective in rapidly clearing the blockage. *Jet ventilation* - Jet ventilation requires a patent airway for effective gas exchange, which is absent in a **completely blocked tracheostomy tube**. - Attempting **jet ventilation** through a blocked tube or directly into the stoma without first clearing the primary obstruction would be ineffective and could potentially cause **barotrauma**.

Q: A case of spontaneous pneumothorax with significant breathlessness comes to you. What will be the initial treatment of choice?

Needle aspiration. ***Needle aspiration*** - **Needle aspiration** is the initial treatment of choice for a **spontaneous pneumothorax**, especially if it is large or causing significant symptoms, as it quickly relieves pressure. - This procedure involves inserting a small needle and catheter into the pleural space to evacuate air, allowing the lung to re-expand. *ICD* - **Intercostal chest drain (ICD)** insertion is typically reserved for larger pneumothoraces, those failing needle aspiration, or recurrent cases. - While effective, it is a more invasive procedure than initial needle aspiration. *IPPV* - **Intermittent positive pressure ventilation (IPPV)** is a form of mechanical ventilation applied in cases of severe respiratory failure, not as an initial treatment for a stable spontaneous pneumothorax. - Administering positive pressure can worsen a pneumothorax if not carefully monitored and managed. *Wait and watch* - A "wait and watch" approach is only appropriate for very **small, asymptomatic spontaneous pneumothoraces** (typically < 1-2 cm from the chest wall). - For symptomatic or larger pneumothoraces, intervention is necessary to prevent further complications and improve respiratory function.

Q: Which of the following is the best treatment for Grade II abdominal hypertension?

Restrictive fluid resuscitation. ***Restrictive fluid resuscitation*** - **Grade II abdominal hypertension** is defined by an intra-abdominal pressure (IAP) between **16-20 mmHg**. At this stage, conservative measures are prioritized over invasive procedures. - **Restrictive fluid resuscitation** involves carefully managing fluid intake to minimize edema and prevent further increases in intra-abdominal pressure (IAP), which can exacerbate symptoms. This is a key non-operative intervention for managing intra-abdominal hypertension. *Immediate decompression* - **Immediate decompression** (e.g., through decompressive laparotomy) is typically reserved for **Grade III or IV abdominal hypertension** or when there is evidence of organ dysfunction due to the elevated pressure. - Decompression is an invasive procedure with associated risks and is not indicated as a first-line treatment for Grade II hypertension where less invasive medical management can be effective. *Normovolemic resuscitation* - **Normovolemic resuscitation** aims to maintain a normal blood volume. While important in trauma, it does not specifically address the underlying issue of increasing IAP in **abdominal hypertension**. - Excessive fluid administration, even to maintain normovolemia, can contribute to interstitial edema and worsen intra-abdominal pressure. *Laparotomy* - **Laparotomy** (surgical opening of the abdomen) is considered a last resort for **abdominal compartment syndrome (ACS)**, which is the most severe form, or when non-operative measures have failed. - For **Grade II abdominal hypertension**, a less invasive approach is preferred. Surgical intervention carries significant risks and is not typically indicated at this stage.

Q: Which of the following statements are correct about Kiel bone? 1. Xenograft 2. Allograft 3. Treated by detergent, sterilized, and freeze-dried 4. Ox or calf bone denatured with 20% H2O2, acetone, and sterilized

1 & 4. ***1 & 4*** - **Kiel bone** is a type of **xenograft**, meaning it is derived from a different species (usually ox or calf). - It is prepared by **denaturing** ox or calf bone with 20% H2O2 and acetone, followed by sterilization, to reduce antigenicity and ensure safety. *2 & 4* - This option incorrectly states that Kiel bone is an **allograft**, while it is, in fact, a **xenograft**. - The preparation method of denaturing with 20% H2O2 and acetone, and sterilization, correctly describes Kiel bone processing. *2 & 3* - This option incorrectly identifies Kiel bone as an **allograft** and states that it is treated by detergent, sterilized, and freeze-dried. - While some bone grafts are treated this way, it is not the specific processing for Kiel bone, which uses H2O2 and acetone. *1 & 3* - This option correctly identifies Kiel bone as a **xenograft**, but incorrectly states its processing involves detergent, sterilization, and freeze-drying. - The distinguishing feature of Kiel bone preparation is the use of **H2O2 and acetone** for denaturing.

Q: The most common site of rupture of the esophagus during rigid esophagoscopy is at

At Killian's dehiscence. ***At Killian's dehiscence*** - This area is a naturally occurring triangular weak point in the posterior pharyngeal wall, formed by the divergent cricopharyngeal muscles, making it particularly susceptible to **perforation** during instrumentation. - Perforation at this site often leads to a **retropharyngeal dissection** of air and contents. *Gastroesophageal junction* - While the gastroesophageal junction is another site of potential perforation, especially due to **narrowing** or the acute angle of entry, it is less common than Killian's dehiscence during rigid esophagoscopy. - Perforation here can lead to a **mediastinal or pleural cavity leak**. *Above cricopharynx* - Perforation above the cricopharynx is less common because the esophagus is typically less constrained and more distensible in this region. - The instrument generally navigates this area with relative ease unless significant **anatomical anomalies** are present. *Near vocal cords* - The vocal cords are located in the larynx, superior to the esophagus. Injury near the vocal cords is more typical of **laryngoscopy** or intubation, not direct esophageal instrumentation. - While instrumentation can lead to laryngeal trauma, direct rupture of the esophagus at this level is exceedingly rare.

Q: Amputation is often not required in:

Chronic osteomyelitis. ***Chronic osteomyelitis*** - While chronic osteomyelitis can be severe, advancements in **antibiotic therapy**, **surgical debridement**, and **reconstructive procedures** often allow for limb salvage. - The goal of treatment is to eradicate infection and preserve function, making amputation a last resort when other methods fail to control infection or restore viability. *Buerger's* - **Buerger's disease** (thromboangiitis obliterans) is characterized by inflammation and thrombosis of small and medium-sized arteries and veins, primarily in the limbs, leading to severe ischemia and gangrene. - Due to progressive vascular damage and frequent lack of effective medical treatment for advanced stages, **amputation is often required** to remove necrotic tissue and manage intractable pain. *diabetic gangrene* - **Diabetic gangrene** results from a combination of **peripheral neuropathy**, **peripheral arterial disease**, and **infection**, leading to tissue death, particularly in the feet. - The compromised blood supply and impaired wound healing in diabetic patients make these lesions prone to rapid progression and severe infection, with **amputation frequently necessary** to prevent systemic sepsis and death. *Gas gangrene* - **Gas gangrene** is a rapidly progressive and life-threatening infection caused by *Clostridium* species, which produce toxins and gas within tissues. - Due to its aggressive and destructive nature, requiring immediate and extensive surgical debridement often involving **amputation of the affected limb** to remove all infected tissue and prevent widespread systemic toxicity.

Question 1

Tarsometatarsal amputation is also known as?

Accepted Answer

Lisfranc amputation

Answer

Pirogoff amputation

Answer

Symes amputation

Answer

Chopart's amputation

Question 2

In a female with appendicitis in pregnancy the treatment of choice is:

Accepted Answer

Surgery at earliest

Answer

Continue pregnancy with medical Rx

Answer

Surgery after delivery

Answer

Abortion with appendectomy

Question 3

Bedsore is an example of:

Accepted Answer

Trophic ulcer

Answer

Venous ulcer

Answer

Post thrombotic ulcer

Answer

Tropical ulcer

Question 4

Polyglactin 910 suture material ("Vicryl") is a / an

Accepted Answer

Absorbable synthetic suture

Answer

Absorbable natural suture

Answer

Non-absorbable synthetic suture

Answer

Non-absorbable natural suture

Question 5

A tracheostomised patient, with Portex tracheostomy tube, in the ward, developed sudden complete blockage of the tube. Which of the following is the best next step in the management -

Accepted Answer

Immediate removal of the tracheostomy tube

Answer

Suction of tube with saline

Answer

Suction of tube with sodium bicarbonate

Answer

Jet ventilation

Question 6

A case of spontaneous pneumothorax with significant breathlessness comes to you. What will be the initial treatment of choice?

Accepted Answer

Needle aspiration

Answer

ICD

Answer

IPPV

Answer

Wait and watch

Question 7

Which of the following is the best treatment for Grade II abdominal hypertension?

Accepted Answer

Restrictive fluid resuscitation

Answer

Immediate decompression

Answer

Normovolemic resuscitation

Answer

Laparotomy

Question 8

Which of the following statements are correct about Kiel bone?
1. Xenograft
2. Allograft
3. Treated by detergent, sterilized, and freeze-dried
4. Ox or calf bone denatured with 20% H2O2, acetone, and sterilized

Accepted Answer

1 & 4

Answer

2 & 4

Answer

2 & 3

Answer

1 & 3

Question 9

The most common site of rupture of the esophagus during rigid esophagoscopy is at

Accepted Answer

At Killian's dehiscence

Answer

Gastroesophageal junction

Answer

Above cricopharynx

Answer

Near vocal cords

Question 10

Amputation is often not required in:

Accepted Answer

Chronic osteomyelitis

Answer

Buerger's

Answer

Diabetic gangrene

Answer

Gas gangrene

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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