Preoperative and Postoperative Care — MCQs

Preoperative and Postoperative Care Indian Medical PG Practice Questions and MCQs

Question 161: A woman presents 4 days after a laparotomy with complete wound dehiscence. After prescribing antibiotics the surgeon decides to suture the wound. Which of these suture materials should he use?

A. Ethilon (Correct Answer)
B. Vicryl
C. Chromic catgut
D. Mersilk

Explanation: ***Ethilon*** * **Ethilon** (nylon) is a **non-absorbable monofilament suture** that is ideal for skin closure, especially in infected or contaminated wounds, because its smooth surface resists bacterial colonization. * Given the wound dehiscence and the potential for infection (antibiotics prescribed), a non-absorbable suture like Ethilon is preferred to provide strong, long-lasting support for surgical closures. *Mersilk* * **Mersilk** (braided silk) is a **non-absorbable multifilament suture** known for its excellent handling properties and knot security. * However, its **multifilament nature** can harbor bacteria in the setting of contaminated or infected wounds, making it less suitable than monofilament sutures for this scenario. *Vicryl* * **Vicryl** (polyglactin 910) is a **synthetic absorbable multifilament suture**. While strong initially, it loses tensile strength over several weeks. * In the context of a dehisced wound requiring long-term support and the potential for infection, an **absorbable suture** would not provide adequate prolonged wound closure strength. *Chromic catgut* * **Chromic catgut** is a **natural absorbable multifilament suture** that offers very short-term tensile strength, absorbed rapidly by the body. * It is generally **not recommended for skin closure**, especially in a reopened surgical wound, due to its rapid degradation and risk of promoting infection.

Question 162: You are asked to put a 22-gauge cannula in a patient. Which of the following cannula will you put?

A. A
B. C (Correct Answer)
C. D
D. B

Explanation: ***C*** - This cannula is blue, which correlates to a **22-gauge** size according to standard color-coding for IV cannulas. - A **22-gauge** cannula matches the specific requirement in the question and is generally used for patients with fragile veins, pediatric patients, or for slow infusions. *A* - This cannula is green, typically indicating an **18-gauge** size. - An 18-gauge cannula provides a larger bore for faster fluid administration but is **too large** for the 22-gauge requirement specified. *B* - This cannula is pink, which corresponds to a **20-gauge** size according to standard color-coding. - A 20-gauge cannula is commonly used for routine infusions but is **larger than the requested 22-gauge** size. *D* - This cannula is yellow, indicating a **24-gauge** size, the smallest common size. - A 24-gauge cannula is **smaller than the requested 22-gauge** and is primarily reserved for very fragile veins and infants.

Question 163: What does the image show? (AIIMS Nov 2018)

A. Pneumatic compression stockings (Correct Answer)
B. Anti-shock garment
C. Alginate dressings
D. Compression stockings (Unna boot)

Explanation: ***Pneumatic compression stockings*** - The image clearly shows sleeves wrapped around the patient's legs, connected by **tubes to a device** that inflates and deflates these sleeves, characteristic of **intermittent pneumatic compression (IPC)**. - IPC devices are used to prevent **deep vein thrombosis (DVT)** by promoting venous blood flow through cyclical compression. *Anti-shock garment* - An anti-shock garment (e.g., **military anti-shock trousers (MAST)**) is a full-body or lower-body suit that applies circumferential pressure to the lower extremities and abdomen to auto-transfuse blood to the core organs in cases of **hypovolemic shock**. - The device in the image covers only the legs and appears to be designed for intermittent, not sustained, compression. *Alginate dressings* - **Alginate dressings** are topical wound care products derived from seaweed, used to absorb exudate from wounds. - They are used directly on wounds and do not involve mechanical devices or full limb coverage like that shown. *Compression stockings (Unna boot)* - While an Unna boot is a type of **sustained compression bandage** (paste bandage) for leg ulcers, it provides continuous, static compression and is typically left in place for days. - The device in the image is clearly an **active, intermittent mechanical system** with a pump, not a static bandage.

Question 164: The following image shows:

A. Chemo-port
B. Ommaya reservoir (Correct Answer)
C. Peripherally inserted Central catheter
D. Thermo-probe

Explanation: ***Ommaya reservoir*** - The image displays an **Ommaya reservoir**, characterized by a **dome-shaped port** connected to a catheter. This device is typically implanted subcutaneously on the scalp and the catheter is placed into a cerebral ventricle. - It is used for repeated access to the **cerebrospinal fluid (CSF)**, primarily for administering chemotherapy directly into the CSF or for drawing CSF samples. *Chemo-port* - A chemo-port (also known as a port-a-cath) is a central venous access device, usually implanted under the skin in the chest, with the catheter tip residing in a large central vein. - While also used for chemotherapy, its structure differs, primarily being a **subcutaneous port** with a catheter ending in the venous system, not directly in brain ventricles like an Ommaya reservoir. *Peripherally inserted Central catheter* - A PICC line is a long, thin tube inserted into a peripheral vein (usually in the arm) and advanced until the tip reaches a large vein in the chest near the heart. - It is used for long-term intravenous access but is not designed for direct access to the cerebrospinal fluid. *Thermo-probe* - A thermo-probe is a device used to measure temperature, often in a medical context for monitoring body temperature during surgery or critical care. - Its design is entirely different, typically consisting of a sensor at the tip of a flexible wire, without the distinct reservoir and catheter structure seen in the image.

Question 165: The image on the left shows a procedure. What is the procedure associated with this image?

A. Amplatzer insertion
B. Seldinger technique (Correct Answer)
C. Venous cut down
D. Aubaniac technique

Explanation: ***Seldinger technique*** - The image illustrates the classic steps of the **Seldinger technique**, involving initial puncture with a needle, insertion of a guidewire through the needle, removal of the needle, and then threading a catheter or introducer sheath over the guidewire. - This technique is widely used for safe percutaneous access to blood vessels and other hollow organs for various medical procedures, such as **central venous catheterization** or **arterial line insertion**. *Amplatzer insertion* - **Amplatzer devices** are used to close septal defects (e.g., ASD, VSD) and patent ductus arteriosus, representing the device itself and its deployment, not the general access technique shown. - The image depicts a general method for vessel access, not the specific insertion and deployment of a cardiovascular occluder. *Venous cut down* - **Venous cutdown** involves surgical incision and direct visualization of a vein to insert a catheter, which is a different, more invasive procedure than the percutaneous access shown. - The depicted method uses a needle and guidewire for blind percutaneous access rather than direct surgical exposure. *Aubaniac technique* - The **Aubaniac technique** is a specific method for central venous access, typically involving the subclavian vein, but it still utilizes a variant of the Seldinger principle for guidewire insertion. - While related to central venous access, "Aubaniac technique" is a more specific application, whereas the image demonstrates the fundamental and broadly applicable **Seldinger technique**.

Question 166: Consider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?

A. II, III and IV
B. I, II and III
C. I, III and IV (Correct Answer)
D. I, II and IV

Explanation: ***I, III and IV*** - **Diabetes** impairs wound healing through microvascular complications, neuropathy, and increased infection risk. - **Renal failure** (III) leads to uremia, malnutrition, and impaired collagen synthesis, all of which compromise wound integrity. - **Jaundice** (IV) is associated with impaired collagen synthesis, reduced fibroblast activity, and increased risk of infection, contributing to poor wound healing. *II, III and IV* - **Hypertension** (II) alone is not a direct risk factor for post-operative wound dehiscence; its complications (e.g., end-organ damage) might indirectly affect healing. - **Renal failure** (III) and **jaundice** (IV) are indeed significant risk factors, but the exclusion of diabetes makes this option incomplete. *I, II and III* - While **diabetes** (I) and **renal failure** (III) are major risk factors, **hypertension** (II) in isolation does not directly cause wound dehiscance. - This option incorrectly omits **jaundice** (IV), which is a known independent risk factor for impaired wound healing. *I, II and IV* - **Diabetes** (I) and **jaundice** (IV) are strong risk factors, but **hypertension** (II) does not directly contribute. - This option incorrectly excludes **renal failure** (III), which is a significant predisposing factor for wound dehiscence.

Question 167: Which of the following are the common complications associated with enteral nutrition in postoperative patients ? 1. Tube malposition, displacement 2. Diarrhoea, constipation 3. Predisposition to systemic sepsis 4. Electrolytic imbalance Select the correct answer using the code given below :

A. 1, 2 and 4
B. 1, 3 and 4
C. 2, 3 and 4
D. 1, 2 and 3 (Correct Answer)

Explanation: ***1, 2 and 3*** - **Tube malposition/displacement** is a common mechanical complication (10-15% incidence), which can lead to ineffective feeding or aspiration into the respiratory tract. - **Diarrhoea and constipation** are frequent gastrointestinal complications (10-20% incidence), occurring due to formula intolerance, rapid infusion rates, or altered gut motility in postoperative patients. - **Predisposition to systemic sepsis**: While enteral nutrition itself has lower infection risk than parenteral nutrition, complications like **aspiration pneumonia** (from tube malposition), **contaminated formula**, and **prolonged ileus** can predispose to severe infections and sepsis in postoperative patients. This is particularly relevant when enteral feeding is improperly managed. *1, 2 and 4* - This combination includes **electrolyte imbalances** (hypokalemia, hypophosphatemia, hypomagnesemia), which are indeed common metabolic complications requiring monitoring. - However, in the context of postoperative patients, the infection risk (sepsis) from aspiration and feeding-related complications is considered a more significant acute complication than electrolyte disturbances, which are generally manageable with proper monitoring and formula adjustment. *1, 3 and 4* - This option incorrectly excludes **diarrhoea and constipation**, which are among the **most common complications** of enteral nutrition, occurring in 10-20% of patients. - GI complications are a primary reason for enteral feeding intolerance and cannot be omitted. *2, 3 and 4* - This option incorrectly omits **tube malposition/displacement**, which is the most important **mechanical complication** directly related to the enteral feeding method. - Without proper tube placement verification, feeding cannot be safely administered, making this a critical complication to recognize.

Question 168: A young 28-year-old male was operated for duodenal ulcer perforation peritonitis. After having recovered well for five days, he developed high fever with chills and symptoms of toxemia. He developed right shoulder tip pain and intractable hiccoughs. The most likely diagnosis is :

A. Subphrenic abscess (Correct Answer)
B. Right lobe liver abscess
C. Surgical site infection
D. Postoperative peritonitis

Explanation: ***Subphrenic abscess*** - The development of **high fever with chills**, **toxemia**, **right shoulder tip pain**, and **intractable hiccups** following a duodenal ulcer perforation repair strongly suggests a subphrenic abscess. - **Diaphragmatic irritation** by the abscess causes referred shoulder pain (due to phrenic nerve irritation) and hiccups. *Right lobe liver abscess* - While a liver abscess can cause fever and chills, **shoulder tip pain** and **hiccups** are less typical compared to a subphrenic abscess, unless the abscess is very superficial and irritating the diaphragm. - A liver abscess often presents with **right upper quadrant pain** and hepatomegaly, which are not mentioned. *Surgical site infection* - A surgical site infection would typically manifest with **localized pain**, **redness**, **swelling**, and possibly **pus discharge** at the incision site, rather than referred shoulder pain or intractable hiccups. - While it can cause fever and toxemia, the specific constellation of symptoms points away from a superficial wound infection. *Postoperative peritonitis* - Postoperative peritonitis would present with more generalized **abdominal pain**, **distension**, **tenderness**, and potentially signs of evolving **sepsis** or **organ dysfunction**. - While it can cause fever and toxemia, the distinct symptoms of **shoulder tip pain** and **hiccups** are less characteristic of diffuse peritonitis.

Question 169: A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is :

A. Myocardial failure due to fluid overload
B. Deep vein thrombosis (Correct Answer)
C. Oedema of renal failure
D. Hypoproteinaemia

Explanation: ***Deep vein thrombosis*** - Postoperative patients, especially those undergoing **abdominal surgery** and those with **malnutrition**, are at high risk for **deep vein thrombosis (DVT)** due to Virchow's triad (venous stasis, endothelial injury, hypercoagulability). - A **painful calf swelling** is a classic symptom of DVT, indicating clot formation within the deep veins of the leg. *Myocardial failure due to fluid overload* - While fluid overload can occur post-surgery, it typically leads to **generalized edema**, shortness of breath, and signs of cardiac dysfunction, not isolated painful calf swelling. - The primary presentation here is a localized, painful swelling, which is less consistent with systemic cardiac issues. *Oedema of renal failure* - **Renal failure** can cause **edema**, but it tends to be **pitting, bilateral, and generalized**, often affecting the ankles and sacral areas. - It would not typically present as a painful, unilateral calf swelling without other signs of kidney dysfunction. *Hypoproteinaemia* - **Hypoproteinaemia**, common in **malnourished** individuals, can cause **generalized non-pitting edema** due to decreased oncotic pressure, not specifically a painful calf swelling. - It would manifest as widespread edema rather than a localized, painful swelling indicative of a thrombotic event.

Question 170: Preoperative investigations done prior to surgery depend upon which of the following? 1. Type of surgery 2. Patient origin 3. Patient comorbidities 4. Experience of surgeon

A. 4. Experience of surgeon
B. 1. Type of surgery (Correct Answer)
C. 2. Patient origin
D. 3. Patient comorbidities

Explanation: ***1. Type of surgery*** - The **type of surgery** is a primary determinant of preoperative investigations, as it defines the baseline assessment needed based on the procedure's complexity, invasiveness, and physiological stress. - Minor surgeries (e.g., superficial excisions) typically require minimal investigations, while major surgeries (e.g., cardiac, neurosurgery) mandate comprehensive cardiovascular, pulmonary, and hematological workups. - **Clinical Note:** In practice, preoperative investigations depend on BOTH the surgery type AND patient comorbidities working together, but this question likely seeks the most fundamental starting point. *3. Patient comorbidities* - **Patient comorbidities** are undeniably crucial in determining the extent and nature of preoperative investigations. - A patient with diabetes, hypertension, or cardiac disease requires additional specific investigations regardless of the surgery type. - However, the surgery type establishes the baseline framework, which is then modified based on comorbidities. *2. Patient origin* - **Patient origin** (geographical location, ethnicity) is generally not a direct determinant of preoperative investigation protocols. - While certain populations may have higher prevalence of specific conditions, investigations are based on individual patient assessment, not origin. *4. Experience of surgeon* - The **experience of the surgeon** does not alter the medical necessity or standard protocols for preoperative investigations. - Patient safety standards and investigation requirements remain consistent regardless of surgical expertise level.

Practice by Chapter

Preoperative Risk Assessment

Practice Questions

Perioperative Management of Comorbidities

Practice Questions

Preparation of Patient for Surgery

Practice Questions

Informed Consent Process

Practice Questions

Post-Anesthesia Care

Practice Questions

Pain Management

Practice Questions

Wound Care and Dressings

Practice Questions

Drain Management

Practice Questions

Postoperative Complications Detection

Practice Questions

Early Ambulation and Rehabilitation

Practice Questions

Enhanced Recovery After Surgery (ERAS) Protocols

Practice Questions

Discharge Planning and Follow-up

Practice Questions

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