General Surgery Principles Practice Questions

Q: Keloid formation is least likely seen over which of the following areas?

Eyelid. **Explanation:** Keloids are benign overgrowths of dense fibrous tissue (collagen) that extend beyond the boundaries of the original wound. Their formation is highly dependent on **skin tension** and the density of skin appendages. **Why Eyelid is the correct answer:** The **eyelid** (along with the scrotum and palms/soles) is characterized by very thin skin with minimal tension and a lack of pilosebaceous units. These anatomical factors make it highly resistant to keloid formation. In clinical practice, keloids are almost never seen on the eyelids, making it the "least likely" site among the options. **Analysis of Incorrect Options:** * **Presternal region:** This is the **most common** site for keloids due to high constant skin tension from the pectoralis muscles and chest wall movement. * **Deltoid/Shoulder:** A very common site, often triggered by vaccinations (like BCG) or trauma, due to high tension during arm movement. * **Ear:** A frequent site for keloids, typically occurring on the lobule following ear piercing. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Keloids extend **beyond** the margin of the original wound and do not regress spontaneously (unlike hypertrophic scars). * **Common Sites (High to Low):** Presternal > Shoulder/Deltoid > Upper back > Ear lobule. * **Rare Sites:** Eyelids, Scrotum, Palms, and Soles. * **Histology:** Characterized by thick, disorganized, "glassy" **Type I and Type III collagen** bundles. * **Treatment:** Intralesional Triamcinolone (steroids) is the first-line medical treatment. Excision alone has a high recurrence rate (>50%).

Q: Which of the following is NOT a feature of a pilonidal sinus?

Recurrence is uncommon. **Explanation:** **Pilonidal Sinus (PNS)** is a chronic inflammatory condition occurring in the natal cleft, primarily caused by the penetration of hair into the skin, leading to a foreign body reaction and track formation. **Why Option D is the correct answer:** Recurrence is actually a **hallmark characteristic** of pilonidal sinus disease. Recurrence rates are high (ranging from 10% to 40% depending on the surgical technique) due to factors like persistent hair growth, inadequate excision of tracks, presence of deep natal clefts, and poor postoperative hygiene. Therefore, the statement "Recurrence is uncommon" is false. **Analysis of Incorrect Options:** * **Option A:** PNS is most **common in young males** (late teens to 20s). This is attributed to thicker body hair, increased sweat production, and deeper natal clefts compared to females. * **Option B:** **Abscess formation** is the most common acute presentation. If the sinus track becomes infected and drainage is blocked, a painful pilonidal abscess develops, requiring incision and drainage. * **Option C:** The **Jack-knife (Kraske) position** is the standard surgical position. The patient is prone with hips flexed and buttocks taped apart to provide optimal exposure of the sacrococcygeal area. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Obesity, sedentary lifestyle ("Jeep Rider’s Disease"), and hirsutism. * **Pathogenesis:** It is an **acquired** condition (Karydakis theory), not congenital. * **Surgical Procedures:** * *Bascom’s Procedure:* For simple disease. * *Karydakis Flap/Limberg Flap:* Transposition flaps used to flatten the natal cleft and reduce recurrence. * **Primary Treatment:** Wide local excision with primary closure or healing by secondary intention.

Q: Early surgery is indicated in which of the following conditions causing peritonitis?

Biliary peritonitis. **Explanation:** In the management of peritonitis, the decision for surgery depends on whether the underlying cause is a chemical insult, a primary infection, or a secondary bacterial perforation. **Why Biliary Peritonitis is the Correct Answer:** Biliary peritonitis is a form of **chemical peritonitis** caused by the leakage of bile into the peritoneal cavity (often due to gallbladder perforation or post-surgical leaks). Bile is highly irritant; it causes rapid fluid shifts, severe inflammation, and carries a high risk of secondary bacterial infection. **Early surgical intervention** is mandatory to source-control the leak, perform peritoneal lavage, and prevent the rapid progression to systemic inflammatory response syndrome (SIRS) and multi-organ failure. **Analysis of Incorrect Options:** * **Amoebiasis Peritonitis:** This is typically a complication of an amoebic liver abscess rupturing into the peritoneum. The primary treatment is **medical management** with intravenous metronidazole and percutaneous aspiration/drainage. Surgery is reserved only for patients who fail to respond to medical therapy or show signs of frank fecal peritonitis. * **Typhoid Peritonitis:** While typhoid can lead to ileal perforation requiring surgery, the initial management focuses on **resuscitation and stabilization** with antibiotics. Surgery is indicated once the patient is hemodynamically stable, but it is not considered as "immediate" or "early" in the same chemical-urgency sense as a bile leak. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Biliary Peritonitis:** Early cholecystectomy or repair of the biliary leak with thorough peritoneal toilet. * **Chemical vs. Bacterial:** Chemical peritonitis (Bile, Gastric Acid) requires faster intervention to prevent the transition to bacterial peritonitis. * **Amoebic Abscess:** "Anchovy sauce" pus is characteristic. Surgery is rarely the first-line treatment.

Q: Which of the following materials used for implants evokes the least inflammatory tissue response?

Polypropylene. **Explanation:** The degree of tissue reaction to an implant or suture material depends on its chemical composition and physical structure. **Polypropylene** is a synthetic, non-absorbable monofilament polymer. Because it is chemically inert and has a smooth, non-porous surface, it evokes the **least inflammatory tissue response** among the options provided. Its monofilament nature also prevents "wicking" of bacteria, making it ideal for use in contaminated fields and for vascular anastomoses. **Analysis of Incorrect Options:** * **Bovine Collagen:** Being a natural protein derived from animals, it is highly immunogenic. It triggers a significant inflammatory response as the body recognizes it as foreign protein and eventually degrades it via enzymatic digestion. * **Polyglactin (Vicryl):** This is a synthetic absorbable braided suture. While it is more inert than natural materials, it is designed to be broken down by hydrolysis. This process, along with its braided structure, induces a moderate inflammatory reaction compared to polypropylene. * **Cotton:** As a natural cellulose-based fiber, cotton evokes a robust inflammatory response. Its multifilament (twisted) structure provides a large surface area for cellular attachment and can harbor bacteria, leading to significant tissue reaction and potential granuloma formation. **High-Yield Clinical Pearls for NEET-PG:** * **Least Reactive:** Polypropylene and Stainless Steel. * **Most Reactive:** Natural materials like Silk and Catgut. * **Suture of Choice:** Polypropylene is the gold standard for **vascular surgery** and **hernia repair (mesh)** due to its high tensile strength and minimal reactivity. * **Absorption Mechanism:** Synthetic sutures (e.g., Polyglactin) are absorbed by **hydrolysis**, whereas natural sutures (e.g., Catgut) are absorbed by **proteolysis/enzymatic digestion**.

Q: Following trauma, which hormone is not released?

Thyroxine. **Explanation:** The metabolic response to trauma is characterized by a complex neuroendocrine activation aimed at maintaining hemodynamic stability and mobilizing energy substrates. This response is divided into the **Ebb phase** (initial shock) and the **Flow phase** (catabolism and hypermetabolism). **Why Thyroxine is the Correct Answer:** Unlike most hormones, **Thyroxine (T4) and Triiodothyronine (T3) levels typically decrease** or remain unchanged following major trauma. This phenomenon is known as "Sick Euthyroid Syndrome." The body downregulates the conversion of T4 to T3 to lower the basal metabolic rate and conserve energy during the acute stress phase. Therefore, it is not "released" in response to trauma. **Analysis of Incorrect Options:** * **Glucagon:** Released by the pancreas in response to catecholamines. It promotes glycogenolysis and gluconeogenesis, contributing to post-traumatic hyperglycemia. * **ADH (Vasopressin):** Released from the posterior pituitary due to hypovolemia and pain. It acts on the kidneys to conserve water and maintain blood pressure. * **GH (Growth Hormone):** Released from the anterior pituitary. While traditionally anabolic, in trauma, it acts synergistically with cortisol to promote lipolysis and insulin resistance. **NEET-PG High-Yield Pearls:** * **Hormones that Increase:** Cortisol (the primary stress hormone), Catecholamines (Adrenaline/Noradrenaline), Glucagon, ADH, GH, and Renin-Angiotensin-Aldosterone. * **Hormones that Decrease:** Insulin (relative deficiency/resistance), T3/T4, and Gonadotropins (Testosterone/Estrogen). * **The "Ebb" Phase:** Characterized by decreased CO, decreased O2 consumption, and decreased body temperature. * **The "Flow" Phase:** Characterized by increased CO, increased O2 consumption, and hypermetabolism.

Q: What is the most common primary source of brain metastases?

Lung. **Explanation:** Brain metastases are the most common intracranial tumors in adults, occurring much more frequently than primary brain malignancies. **Why Lung is Correct:** **Lung cancer** is the most common primary source, accounting for approximately **40–50%** of all brain metastases. This is due to the high incidence of lung cancer and its unique hematogenous spread pattern; cancer cells entering the pulmonary circulation gain direct access to the systemic arterial circulation, allowing them to bypass the "filter" of the lungs and seed directly into the brain. Small cell lung cancer (SCLC) has a particularly high propensity for early CNS involvement. **Analysis of Incorrect Options:** * **Breast Cancer (Option C):** This is the **second most common** source (approx. 15–25%). It is more common in younger women and specifically associated with HER2-positive and Triple-Negative subtypes. * **Melanoma (Option D):** While melanoma has the **highest propensity** (percentage risk per individual case) to spread to the brain, it is less common overall than lung or breast cancer due to its lower general incidence. * **Liver (Option B):** Primary Hepatocellular Carcinoma (HCC) rarely metastasizes to the brain; it more commonly spreads to the lungs or bone. **NEET-PG High-Yield Pearls:** 1. **Most common source overall:** Lung > Breast > Melanoma > Renal > GI. 2. **Highest propensity to bleed:** Melanoma, Choriocarcinoma, Renal Cell Carcinoma (RCC), and Thyroid cancer. 3. **Location:** Most brain metastases (80%) occur in the cerebral hemispheres, typically at the **grey-white matter junction** where narrowing vessel diameters trap tumor emboli. 4. **Multiplicity:** Lung cancer and melanoma usually present with multiple lesions, whereas Breast, RCC, and Colon cancer often present as a solitary metastasis.

Question 1

Keloid formation is least likely seen over which of the following areas?

Accepted Answer

Eyelid

Answer

Ear

Answer

Deltoid

Answer

Presternal region

Question 2

A patient developed a wound infection post laparotomy for pyoperitoneum and was treated conservatively. Granulation tissue is now seen in the wound. What is the next step in management?

Accepted Answer

Resuturing with interrupted stitches

Answer

Daily dressing

Answer

Mesh repair

Answer

Incision and drainage

Question 3

Following an oral surgical procedure, the surgical site is covered with a gauze wetted with saline because:

Accepted Answer

Saline decreases the tendency of the clot to get embedded in gauze mesh.

Answer

Saline promotes local hemostasis at the site.

Answer

Saline has localized anti-inflammatory action.

Answer

Saline accelerates the healing of the wound.

Question 4

Which of the following is NOT a feature of a pilonidal sinus?

Accepted Answer

Recurrence is uncommon

Answer

Common in young males

Answer

Abscess formation

Answer

Jack knife position is used for surgery

Question 5

Early surgery is indicated in which of the following conditions causing peritonitis?

Accepted Answer

Biliary peritonitis

Answer

Amoebiasis peritonitis

Answer

Typhoid peritonitis

Answer

All of the above

Question 6

Which of the following materials used for implants evokes the least inflammatory tissue response?

Accepted Answer

Polypropylene

Answer

Bovine collagen

Answer

Polygiactin

Answer

Cotton

Question 7

Following trauma, which hormone is not released?

Accepted Answer

Thyroxine

Answer

Glucagon

Answer

ADH

Answer

GH

Question 8

In a splenectomized patient, there is an increased risk of infection by which of the following organisms?

Accepted Answer

Staphylococcus aureus

Answer

Pneumococci

Answer

Klebsiella

Answer

Haemophilus influenzae

Question 9

What is the most common primary source of brain metastases?

Accepted Answer

Lung

Answer

Liver

Answer

Breast

Answer

Melanoma

Question 10

A 43-year-old man presents with severe perineal pain. Examination reveals exquisite tenderness to the right of the anal verge due to a perianal abscess. Rectal examination is refused. What is the next step in management?

Accepted Answer

Drainage of the abscess in the office under local anesthesia.

Answer

Excision of the vertical fold of Morgagni.

Answer

Drainage under general anesthesia and immediate colonoscopy.

Answer

CT scan of the abdomen.

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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