General Surgery Principles — MCQs

General Surgery Principles Indian Medical PG Practice Questions and MCQs

Question 931: Most common congenital diaphragmatic hernia is:

A. Bochdalek hernia (Correct Answer)
B. Morgagni hernia
C. None of the options
D. Paraesophageal hernia

Explanation: ***Bochdalek hernia*** - This is the most common type of **congenital diaphragmatic hernia (CDH)**, accounting for approximately **95% of all CDH cases**. - It occurs due to a defect in the **posterolateral diaphragm** (pleuroperitoneal membrane), typically on the **left side**. - Presents in neonates with respiratory distress due to herniation of abdominal contents into the thorax. *Morgagni hernia* - This is a rare type of **congenital diaphragmatic hernia**, occurring through the **anterior retrosternal diaphragm** (foramen of Morgagni). - Accounts for only **2-5% of all CDH cases**, usually on the right side. - Often asymptomatic and diagnosed incidentally in adults. *Paraesophageal hernia* - This is an **acquired hiatal hernia** where part of the stomach herniates alongside the esophagus through the esophageal hiatus. - While **hiatal hernias are the most common diaphragmatic hernias overall**, they are **not congenital** and therefore not the answer to this question. - Seen commonly in older adults. *None of the options* - Incorrect, as **Bochdalek hernia** is definitively the most common congenital diaphragmatic hernia.

Question 932: Which of the following hernias has the highest risk of strangulation?

A. Indirect
B. Spigelian (Correct Answer)
C. Direct
D. Incisional

Explanation: ***Spigelian*** - **Spigelian hernias** occur through a defect in the **Spigelian aponeurosis** (between the semilunar line and lateral border of rectus abdominis), typically inferior to the arcuate line. - They have a **high risk of strangulation (20-25%)** due to their **narrow fascial defect** and tendency to become incarcerated through the layers of the abdominal wall. - The hernia often becomes **interparietal** (between muscle layers), making it difficult to detect clinically, which increases the risk of delayed presentation and strangulation. *Indirect* - **Indirect inguinal hernias** pass through the **deep inguinal ring** and follow the inguinal canal, potentially entering the scrotum. - While they do have a narrow neck that can cause strangulation, their **strangulation risk is moderate (~10-15%)**, lower than Spigelian hernias. - They are the most common type of hernia but not the highest risk for strangulation among these options. *Direct* - **Direct inguinal hernias** protrude through **Hesselbach's triangle** in the posterior wall of the inguinal canal. - They have a **broad-based neck**, making strangulation relatively uncommon (~5%). - The wider defect allows easier reduction and less constriction of contents. *Incisional* - **Incisional hernias** develop at previous surgical incision sites due to fascial weakness or inadequate healing. - While they can incarcerate, they typically have a **wider neck** and **lower strangulation risk** compared to Spigelian or indirect inguinal hernias. - Risk varies with defect size, but generally not the highest among common hernia types.

Question 933: What are the metabolic consequences of ureterosigmoidostomy?

A. Hyperchloremic with hypokalemic acidosis (Correct Answer)
B. Hyperkalemia
C. Metabolic alkalosis
D. Hyponatremia

Explanation: ***Hyperchloremic with hypokalemic acidosis*** - In ureterosigmoidostomy, the reabsorption of urinary constituents like **chloride** and **urea** from the bowel mucosa leads to **hyperchloremia**. - The exchange of **chloride** for **bicarbonate** and the concomitant loss of **potassium** from the colon results in **hypokalemic metabolic acidosis**. *Hyperkalemia* - Colonic reabsorption of urinary products typically causes **potassium wasting** and **hypokalemia**, not hyperkalemia. - While some potassium is reabsorbed, the overall effect due to the exchange for hydrogen ions and fluid loss from the colon is a net decrease in serum potassium. *Metabolic alkalosis* - Metabolic alkalosis involves an increase in **bicarbonate**, which is the opposite of what occurs in ureterosigmoidostomy where bicarbonate is lost. - The increased reabsorption of urea and chloride from the urine in the colon leads to an **acidic state** due to increased **hydrogen ion production** and **bicarbonate depletion**. *Hyponatremia* - Although some **sodium** reabsorption can occur, the primary electrolyte imbalances are related to chloride, potassium, and bicarbonate. - While some intestinal urinary diversion procedures can lead to hyponatremia due to volume changes or syndrome of inappropriate antidiuretic hormone (SIADH), it is not the most characteristic or direct metabolic consequence of ureterosigmoidostomy itself.

Question 934: What is the first aid treatment for acid contact with the skin?

A. Wash with strong alkali
B. Wash with copious amounts of water (Correct Answer)
C. Refer to higher centre
D. Wash with mild alkali agent

Explanation: ***Wash with copious amounts of water*** - The primary first aid for acid contact with the skin is immediate and prolonged **irrigation with copious amounts of water**. This helps to dilute the acid and wash away residual chemicals, minimizing tissue damage. - Flushing should continue for at least **20-30 minutes** or until medical help arrives, even if the pain subsides, to ensure thorough removal of the corrosive agent. *Wash with strong alkali* - Using a strong alkali to neutralize an acid burn can lead to an **exothermic reaction**, generating significant heat and causing further tissue damage. - This approach carries a high risk of worsening the chemical burn and should be strictly avoided. *Refer to higher centre* - While referral to a higher center may be necessary for severe burns, it is not the **immediate first aid step**. Delaying initial management to seek advanced care can worsen the burn. - **Immediate irrigation** is crucial to prevent further chemical injury and should precede any transfer decisions. *Wash with mild alkali agent* - Similar to strong alkalis, even a mild alkali agent can cause an **exothermic reaction** when mixed with acid on the skin, potentially increasing tissue damage rather than mitigating it. - The most effective and safest approach is **dilution with water**, not neutralization with bases.

Question 935: Which of the following materials is most commonly used for surgical instruments?

A. Stainless steel (Correct Answer)
B. Titanium
C. Carbon steel
D. Cobalt-chromium alloys

Explanation: ***Stainless steel*** - **Stainless steel**, specifically surgical grade 316L, is the most common material due to its **corrosion resistance**, **high strength**, and **biocompatibility**, making it suitable for repeated sterilization and direct contact with tissues. - Its durability and ability to maintain a sharp edge under various surgical conditions contribute to its widespread use across many types of instruments. *Titanium* - **Titanium** is known for its **lightweight** and **non-magnetic** properties, making it ideal for specialized instruments, particularly in neurosurgery or MRI-guided procedures, but it is more expensive than stainless steel. - While highly biocompatible and corrosion-resistant, its cost and ductility mean it's not the primary choice for the majority of general surgical instruments. *Carbon steel* - **Carbon steel** can achieve a very **sharp edge** and is used for certain cutting instruments like scalpels, but it is highly susceptible to **corrosion** and rust, especially after repeated sterilization. - This lack of corrosion resistance limits its use for instruments that require frequent washing and re-sterilization, making it less practical for general use than stainless steel. *Cobalt-chromium alloys* - **Cobalt-chromium alloys** are primarily used for **implants** and high-wear components like joint replacements due to their **excellent wear resistance** and strength. - They are not typically used for general surgical instruments because of their cost, weight, and the fact that their superior wear properties are not necessary for most handheld tools.

Question 936: What is the primary use of emery in medical applications?

A. Gemstone in jewelry
B. Exfoliant in skincare
C. Abrasive for polishing (Correct Answer)
D. Cosmetic for adding color

Explanation: **Abrasive for polishing** - Emery is a naturally occurring rock type, a form of **corundum** (aluminum oxide), known for its extreme hardness. - Its abrasive properties make it ideal for **grinding, sanding, and polishing** various materials, including dental restorations and medical instruments. *Exfoliant in skincare* - While exfoliation involves abrasive action, emery's particles are generally too **coarse and irregular** for safe and effective use on human skin. - Skincare exfoliants typically use much finer, more uniform particles to prevent **micro-tears or irritation**. *Gemstone in jewelry* - Although emery contains corundum, which is also the mineral basis for gemstones like ruby and sapphire, emery itself is an **impure, opaque, and non-gem-quality** form. - Its value lies in its **industrial applications** rather than its aesthetic appeal for jewelry. *Cosmetic for adding color* - Emery is a **dark, dull-colored** mineral (often black or dark gray) and does not possess the vibrant pigments or light-reflecting properties desired for cosmetic coloring. - Cosmetic colorants typically involve finely milled **pigments** from a wide range of natural or synthetic sources.

Question 937: What is the primary use of crocus cloth in medical applications?

A. Finishing wood surfaces
B. Cleaning metal surfaces
C. Polishing surgical instruments (Correct Answer)
D. Sanding surfaces

Explanation: ***Polishing surgical instruments*** - **Crocus cloth** is a very fine abrasive material primarily used for achieving a high polish on **metals**, including those used in surgical instruments. - This polishing action helps to ensure the instruments are smooth, free of imperfections, and less likely to harbor microorganisms, promoting **sterilization** and longevity. *Finishing wood surfaces* - While crocus cloth can smooth surfaces, its primary application is not **wood finishing**; other abrasives like **sandpaper** are more commonly used for this purpose. - Finishing wood typically requires a range of grits to progressively smooth the surface, which is not the main role of crocus cloth. *Cleaning metal surfaces* - **Crocus cloth** is used for polishing, which involves removing very fine surface imperfections and achieving a shine, rather than rough **cleaning** of heavily soiled metal surfaces. - For generalized cleaning, **solvents** or other abrasive cleaners might be employed, depending on the type and extent of contamination. *Sanding surfaces* - **Sanding** generally implies a more aggressive removal of material or preparation of a surface for coating, using coarser **abrasives**. - Crocus cloth is an extremely fine abrasive suitable for final polishing, not for general **sanding** or initial material removal.

Question 938: In a sutured surgical wound, the process of epithelialization is completed within what timeframe?

A. 48 hours (Correct Answer)
B. Less than 48 hours
C. More than 72 hours
D. More than 48 hours but less than 72 hours

Explanation: ***48 hours*** - **Epithelialization** in a clean, sutured surgical wound is typically completed within **48 hours**, forming a complete protective epithelial barrier. - This timeframe is crucial for preventing external contaminants from entering the wound and marks when the wound can be safely exposed to water. *Less than 48 hours* - While initial **epithelial migration** begins within hours of wound closure, **complete epithelialization** with a fully formed protective barrier requires up to **48 hours**. - The wound remains vulnerable to bacterial penetration if exposed to contaminants before the epithelial barrier is complete. *More than 72 hours* - If **epithelialization** takes **more than 72 hours** in a simple sutured wound, it indicates impaired healing, possible wound complications, or infection. - Prolonged epithelialization beyond this timeframe suggests deviation from the normal wound healing process. *More than 48 hours but less than 72 hours* - Although wound strength continues to increase through collagen deposition over weeks, the primary protective **epithelial barrier** is established by **48 hours**. - The completion of epithelialization within 48 hours is the standard timeframe for primary intention healing in sutured wounds.

Question 939: What is the purpose of tilting the cast during surveying?

A. Achieve maximum guiding planes
B. Create undercuts
C. Obtain a favorable path of insertion (Correct Answer)
D. Obtain retention

Explanation: ***Obtain a favorable path of insertion*** - Tilting the cast allows the dental professional to analyze the various **undercuts** and **interferences** on the teeth and surrounding tissues. - By adjusting the cast's orientation, an **optimal path of insertion** can be identified, minimizing interferences and ensuring the proper seating of a dental prosthesis. *Achieve maximum guiding planes* - While guiding planes are important for stability and resistance to displacement, the primary purpose of cast tilting is not to maximize them directly. - **Guiding planes** are prepared on the teeth to create parallel surfaces, which are then evaluated and utilized after the optimal path of insertion is determined. *Create undercuts* - The purpose of tilting is to identify and utilize existing **undercuts** for retention, not to create them. - **Undercuts** are naturally present areas below the height of contour, and tilting helps in selecting the most appropriate ones for clasp engagement. *Obtain retention* - While tilting the cast ultimately contributes to effective **retention** by identifying suitable undercuts, it is part of the broader goal of establishing a functional path of insertion. - **Retention** is achieved by the engagement of retentive clasps into specific undercuts that are identified during the surveying process, after determining the path of insertion.

Question 940: Which finding is assigned 2 points in the Alvarado scoring system for appendicitis assessment?

A. Low-grade fever
B. Leukocytosis (Correct Answer)
C. Nausea and vomiting
D. Rebound tenderness

Explanation: **Leukocytosis** - An elevated **white blood cell count** (typically greater than 10,000 cells/mm³) is a significant indicator of inflammation, assigned **2 points** in the Alvarado score. - This finding reflects the body's systemic response to the infection and inflammation associated with **appendicitis**. *Low-grade fever* - A low-grade fever (oral temperature of 37.3-38.0°C) is assigned **1 point** in the Alvarado score. - While indicative of inflammation, it is less specific and less weighted than leukocytosis. *Nausea and vomiting* - These gastrointestinal symptoms are common in appendicitis and are assigned **1 point** in the Alvarado score. - They are non-specific and can be present in many other abdominal conditions. *Rebound tenderness* - This clinical sign, indicating **peritoneal irritation**, is assigned **1 point** in the Alvarado score. - It is a physical exam finding, not a laboratory finding, and suggests localized inflammation.

Practice by Chapter

Wound Healing and Care

Practice Questions

Surgical Infections

Practice Questions

Fluid and Electrolyte Management

Practice Questions

Nutrition in Surgical Patients

Practice Questions

Hemostasis and Blood Transfusion

Practice Questions

Surgical Instruments and Equipment

Practice Questions

Sutures and Stapling Devices

Practice Questions

Minimal Access Surgery Principles

Practice Questions

Surgical Complications

Practice Questions

Anesthesia Principles for Surgeons

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Surgical Oncology Principles

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Evidence-Based Surgery

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