General Surgery Principles Practice Questions

Q: Which of the following sutures has maximum tensile strength and minimum tissue reaction?

Polypropylene. ***Polypropylene*** - Polypropylene is a **non-absorbable monofilament suture** known for its exceptional tensile strength and very low tissue reactivity. - Its **monofilament structure prevents bacterial harborage** and makes it suitable for vascular and cardiovascular surgeries where long-term strength is crucial. *Poliglecaprone* - Poliglecaprone (Monocryl) is a **synthetic absorbable monofilament suture** that offers good tensile strength initially but loses it rapidly over 2-3 weeks. - While it has minimal tissue reaction, its **absorbable nature** prevents it from maintaining long-term tensile strength. *Polyglactin* - Polyglactin (Vicryl) is a **synthetic absorbable braided suture** known for its high initial tensile strength that is retained for 2-3 weeks, with complete absorption in 56-70 days. - Its braided structure can lead to slightly more tissue reaction and a perceived higher risk of infection compared to monofilaments. *Polydioxanone* - Polydioxanone (PDS) is a **synthetic absorbable monofilament suture** that maintains its tensile strength for a longer period than other absorbable sutures (up to 6 weeks) but eventually degrades. - While it has good handling characteristics and low tissue reaction, its **absorbable nature** means it cannot provide permanent wound support.

Q: What is another name for Pantaloon hernia?

Saddle bag hernia. ***Saddle bag hernia*** - A **Pantaloon hernia** is characterized by having both a **direct** and an **indirect inguinal hernia** coexisting side-by-side, straddling the **inferior epigastric artery**. - The term **"saddle bag hernia"** is the most commonly used alternate name, describing how the hernia straddles the inferior epigastric artery like **saddlebags** over a horse. - This is the established synonym in surgical literature and examination contexts. *Dual hernia* - While descriptive of the "dual" or two-sided nature (direct + indirect components), this is **not the recognized alternate name** for Pantaloon hernia. - It is an anatomical description rather than an established medical terminology. *Retrosternal hernia* - A **retrosternal hernia** (or **Morgagni hernia**) is a type of **diaphragmatic hernia** where abdominal contents protrude into the chest through a defect behind the sternum. - This is unrelated to inguinal hernias and describes a completely different anatomical location and type of defect. *Bochdalek's hernia* - **Bochdalek's hernia** is another type of **diaphragmatic hernia**, typically occurring posterolaterally through a defect in the diaphragm, often presenting in infants. - It involves the displacement of abdominal organs into the thoracic cavity and is distinct from inguinal hernias.

Q: Prolonged surgery time of vaginal hysterectomy may lead to damage to which of the following nerves?

Peroneal. ***Peroneal*** - Prolonged surgery time in the **lithotomy position**, often used for vaginal hysterectomy, can lead to compression of the **peroneal nerve (specifically the common peroneal nerve)** against the lateral aspect of the fibula head, causing neuropathy. - This compression is often due to sustained pressure from leg supports or stirrups during lengthy procedures. *Obturator* - The **obturator nerve** is located deep within the pelvis and is more commonly injured during dissection in the deep pelvic sidewalls or due to traction during procedures like lymphadenectomy. - Its injury is less typically associated with prolonged positioning during routine vaginal hysterectomy than the peroneal nerve. *Pudendal* - The **pudendal nerve** can be injured during vaginal delivery or prolonged compression from bike seats, but its injury during vaginal hysterectomy in the lithotomy position is less common than peroneal nerve injury. - While prolonged sitting can affect it, the direct compression mechanism seen with leg supports typically targets the peroneal nerve. *Sural* - The **sural nerve** is a sensory nerve in the calf and ankle and is generally not at high risk during vaginal hysterectomy performed in the lithotomy position. - Its common injury mechanisms include trauma to the lower leg or ankle surgery, not typically sustained positioning in the operating room.

Q: Which of the following is typical of rectus sheath hematoma?

Firm painful mass. ***Firm painful mass*** - A rectus sheath hematoma typically presents as a **firm, painful, and often well-circumscribed mass** within the abdominal wall. - The pain is usually localized to the site of the hematoma, often in the **lower quadrants of the abdomen**. *Bluish discoloration* - While some hematomas can cause skin discoloration, **bluish discoloration** (like a bruise) is possible but not the most defining or typical feature of a rectus sheath hematoma itself. - More often, the discoloration may be delayed or less prominent, especially with **deeper hematomas**. *Ecchymosis* - **Ecchymosis** (bruising) can occur with a rectus sheath hematoma if the bleeding is superficial or extensive enough to reach the skin. - However, it's not universally present and the defining characteristic is the presence of a **palpable mass**. *Severe tenderness* - **Severe tenderness** is certainly present, but it's part of the broader symptomology that includes a **palpable, firm mass**. - Without the presence of a mass, severe tenderness alone is less specific to rectus sheath hematoma compared to the combination of a **firm, painful mass**.

Q: What is the medical procedure that involves the removal of dead, damaged, or infected tissue from a wound?

Debridement. ***Debridement*** - **Debridement** is the precise medical term referring to the removal of **dead**, damaged, or infected tissue to promote wound healing. - This procedure is crucial for preventing infection, reducing inflammation, and allowing healthy tissue to regenerate. *Surgical removal of tissue* - While debridement can be performed surgically, "surgical removal of tissue" is a broader, less specific term and does not exclusively refer to the removal of *dead* or *damaged* tissue from a wound. - This term could apply to the removal of healthy tissue (e.g., in a biopsy) or diseased tissue that is not necessarily dead or damaged (e.g., tumor excision). *Cleaning of the wound* - **Cleaning of the wound**, often called irrigation, involves removing foreign particles, debris, and surface contaminants but does not specifically refer to the removal of **necrotic** or **non-viable tissue**. - Wound cleaning is typically a preparatory step for debridement or dressing changes, not the process of tissue removal itself. *Application of antiseptic* - The **application of antiseptic** involves using chemical agents to inhibit the growth of microorganisms on living tissue to prevent infection, not the physical removal of tissue. - Antiseptics reduce the bioburden but do not remove necrotic tissue, which often harbors bacteria.

Q: Most important factor in causation of ingrown toenail is?

Ill fitting shoes. ***Ill fitting shoes*** - **Tight or narrow shoes** compress the toes, pushing the soft tissue against the nail edge, leading to the nail growing into the skin. - This consistent pressure and irritation are a primary mechanical cause of **onychocryptosis**. *Fungal infection* - While fungal infections (onychomycosis) can cause nail thickening and deformity, they are not the primary cause of an ingrown toenail itself. - Fungal infections primarily affect the **nail plate** and **nail bed**, changing nail texture and color. *Genetic predisposition* - While certain **foot shapes** or **nail plate curvatures** may make an individual more prone to ingrown toenails, genetic factors are not the most direct or modifiable cause. - Genetic predisposition may increase susceptibility, but external factors like footwear are often the precipitating cause. *Nutritional deficiency* - Nutritional deficiencies can affect nail health, leading to brittleness, slow growth, or abnormal nail plates. - However, they do not directly cause the nail to **penetrate the surrounding skin**, which is the hallmark of an ingrown toenail.

Q: Which type of healing occurs in an incisional wound with infection?

Secondary. ***Secondary*** - **Infection** prevents immediate closure, requiring the wound to heal by **granulation, contraction, and epithelialization**. - This process leads to a larger scar compared to primary closure. - In an infected wound, closure would trap bacteria and lead to abscess formation, so the wound must heal by **secondary intention**. *Primary* - Occurs when wound edges are **cleanly approximated** without significant tissue loss or infection, allowing for direct re-epithelialization. - This leads to the **fastest healing** and **minimal scarring**. - Requires clean wound with minimal bacterial contamination. *Delayed primary* - Involves leaving the wound open initially (3-5 days) to allow for **drainage or reduction of contamination** in a potentially contaminated wound. - The wound is then **surgically closed before granulation tissue forms** once the risk of infection is reduced. - Also called **tertiary intention** by some authors. *Tertiary* - Refers to a wound that is initially left open to heal by **secondary intention with granulation tissue formation**. - The wound is then **closed surgically after granulation tissue has formed**. - Distinct from delayed primary closure, which occurs before granulation develops.

Q: Normal time for wound healing to transition from proliferative to maturation phase after injury is?

3 weeks. ***4 weeks*** - The normal time for scar formation is generally around **4 weeks**, allowing for significant collagen deposition and remodeling [1]. - This timeframe signifies the transition from initial wound healing to the maturation phase where the scar solidifies. *2 weeks* - At 2 weeks, the healing is in the **inflammatory** and early proliferative phase, not fully developed into a scar. - Scar formation generally requires a longer duration for sufficient **collagen synthesis** and tissue remodeling. *3 weeks* - By 3 weeks, the wound is progressing, but it still lacks the **structural integrity** of a mature scar. - Scar formation typically reaches its recognizable stage by **4 weeks**, with formal remodeling continuing thereafter. *5 weeks* - While healing continues past 4 weeks, **5 weeks** is longer than the typical duration for initial scar formation, possibly suggesting delayed healing. - By this point, the scar should be present, but significant remodeling will still occur beyond this period. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 117-119.

Q: Which of the following is NOT a criterion for the viability of muscle?

Intact fascia. ***Intact fascia*** - The **fascia** is a connective tissue sheath surrounding muscles; its intactness is **not a direct indicator of muscle viability**. - While important for muscle integrity and function, a healthy, viable muscle can still exist even if its overlying fascia is disrupted or surgically opened. *Colour* - **Healthy muscle** generally has a **reddish-pink colour** due to its rich blood supply and myoglobin content. - **Pale, dusky, or black muscle** suggests **ischemia or necrosis**, indicating poor viability. *Contractility* - **Viable muscle** should be able to **contract** in response to direct electrical stimulation or mechanical irritation. - The **absence of contractility** indicates **muscle death or severe damage**, making it non-viable. *Bleeding when cut* - **Viable muscle** has an **intact blood supply** and will **bleed when incised**. - **Lack of bleeding** suggests **severe ischemia or necrosis**, indicating the muscle is non-viable.

Question 1

Which of the following sutures has maximum tensile strength and minimum tissue reaction?

Accepted Answer

Polypropylene

Answer

Poliglecaprone

Answer

Polydioxanone

Answer

Polyglactin

Question 2

Which of the following statements regarding hydrocele management and characteristics is correct?

Accepted Answer

Jaboulay's procedure involves eversion of the tunica vaginalis

Answer

Lord's plication is contraindicated in thick-walled hydroceles

Answer

Communicating hydrocele is more common in adults than children

Answer

Aspiration is the preferred definitive treatment for primary hydrocele

Question 3

What is another name for Pantaloon hernia?

Accepted Answer

Saddle bag hernia

Answer

Retrosternal hernia

Answer

Dual hernia

Answer

Bochdalek's hernia

Question 4

Prolonged surgery time of vaginal hysterectomy may lead to damage to which of the following nerves?

Accepted Answer

Peroneal

Answer

Obturator

Answer

Sural

Answer

Pudendal

Question 5

Which of the following is typical of rectus sheath hematoma?

Accepted Answer

Firm painful mass

Answer

Bluish discoloration

Answer

Ecchymosis

Answer

Severe tenderness

Question 6

What is the medical procedure that involves the removal of dead, damaged, or infected tissue from a wound?

Accepted Answer

Debridement

Answer

Surgical removal of tissue

Answer

Cleaning of the wound

Answer

Application of antiseptic

Question 7

Most important factor in causation of ingrown toenail is?

Accepted Answer

Ill fitting shoes

Answer

Fungal infection

Answer

Genetic predisposition

Answer

Nutritional deficiency

Question 8

Which type of healing occurs in an incisional wound with infection?

Accepted Answer

Secondary

Answer

Primary

Answer

Delayed primary

Answer

Tertiary

Question 9

Normal time for wound healing to transition from proliferative to maturation phase after injury is?

Accepted Answer

3 weeks

Answer

2 weeks

Answer

4 weeks

Answer

5 weeks

Question 10

Which of the following is NOT a criterion for the viability of muscle?

Accepted Answer

Intact fascia

Answer

Contractility

Answer

Colour

Answer

Bleeding when cut

General Surgery Principles — MCQs

General Surgery Principles — MCQs

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