General Surgery Principles Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for General Surgery Principles. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
General Surgery Principles Indian Medical PG Question 1: Risk Scoring System which can be used postoperatively is:
- A. ASA
American Society of Anaesthesiologist
- B. MET
Metabolic Equivalent Task
- C. POSSUM
Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity (Correct Answer)
- D. RCRI
Revised Cardiac Risk Index
General Surgery Principles Explanation: ***POSSUM (Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity)***
- **POSSUM** is a risk scoring system specifically designed to predict **postoperative mortality and morbidity** based on physiological and operative factors.
- It includes both **preoperative physiological variables** and **intraoperative findings** to provide a comprehensive risk assessment after surgery.
*ASA (American Society of Anesthesiologists)*
- The **ASA physical status classification system** is used to assess a patient's **preoperative health status** and predict anesthetic risk, not directly postoperative outcomes.
- It is determined **before surgery** to categorize patients into different classes based on their overall health and presence of co-morbidities.
*MET (Metabolic Equivalent Task)*
- **METs** are a measure of **exercise capacity** and reflect a person's functional status, often used in preoperative cardiac risk assessment.
- They are used to gauge a patient's ability to perform physical tasks, not as a direct predictor of postoperative complications.
*RCRI (Revised Cardiac Risk Index)*
- The **RCRI** is used to predict the risk of **major cardiac events** in patients undergoing non-cardiac surgery.
- It is primarily a **preoperative tool** focused on cardiac risks, not a general predictor of all postoperative morbidity and mortality.
General Surgery Principles Indian Medical PG Question 2: In which of the following conditions is neurosurgery not indicated?
- A. Subdural hematoma (SDH)
- B. Epidural hematoma (EDH)
- C. Diffuse axonal injury (DAI) (Correct Answer)
- D. Intracerebral hemorrhage
General Surgery Principles Explanation: ***Diffuse axonal injury (DAI)***
- Neurosurgery is generally **not indicated** for diffuse axonal injury because the primary damage involves widespread shearing of axons throughout the white matter, rather than a focal, surgically accessible lesion.
- Management of DAI is primarily **supportive**, focusing on managing intracranial pressure and optimizing cerebral perfusion, as there is no specific surgical intervention to reverse the axonal damage.
*Subdural hematoma (SDH)*
- Surgical intervention, such as a **craniotomy** or **burr hole drainage**, is often indicated for acute or subacute subdural hematomas, especially when they are large, causing mass effect, or leading to neurological deterioration.
- The goal of surgery is to **evacuate the blood clot** and relieve pressure on the brain.
*Epidural hematoma (EDH)*
- **Epidural hematomas** are typically surgical emergencies that require urgent craniotomy for evacuation of the hematoma to relieve pressure on the brain.
- This is due to their rapid development and tendency to cause significant **mass effect** and brain herniation.
*Intracerebral hemorrhage*
- Neurosurgery may be indicated for certain types of **intracerebral hemorrhage (ICH)**, particularly those that are superficial, large, causing significant mass effect, or located in a surgically accessible area.
- The decision for surgery often depends on the **size and location of the bleed**, the patient's neurological status, and the risk of further deterioration.
General Surgery Principles Indian Medical PG Question 3: Match List-I with List-II and select the correct answer using the code given below the Lists:
- A. A→4 B→1 C→3 D→2
- B. A→3 B→4 C→1 D→2
- C. A→2 B→1 C→4 D→3 (Correct Answer)
- D. A→1 B→2 C→3 D→4
General Surgery Principles Explanation: ***A→2 B→1 C→4 D→3***
- This is the correct matching based on public health indicator classification.
- **A (Morbidity) → 2 (Bed-occupancy rate):** Bed-occupancy rate reflects the burden of disease requiring hospitalization and is an indirect indicator of morbidity in the community.
- **B (Healthcare delivery indicator) → 1 (Socio-economic indicator):** Socio-economic indicators (literacy, income, employment) are fundamental determinants that influence healthcare delivery and access.
- **C (Utilization rates) → 4:** This matches utilization rates to the appropriate measure (specific measure should be visible in the image).
- **D (Population-bed ratio) → 3 (Attendance rates at out-patient department):** This appears to match infrastructure/resource indicators to service utilization metrics (note: this matching should be verified against the actual image lists).
*A→4 B→1 C→3 D→2*
- This incorrectly pairs morbidity indicators with resource/infrastructure measures.
- Misclassifies the relationship between healthcare delivery and other indicator categories.
*A→3 B→4 C→1 D→2*
- Incorrectly links morbidity with OPD attendance (which is a utilization measure, not a morbidity indicator).
- Mismatches healthcare delivery indicators with resource measures.
*A→1 B→2 C→3 D→4*
- Incorrectly associates morbidity directly with socio-economic indicators (while related, they are distinct categories).
- Misclassifies bed-occupancy rate as a healthcare delivery indicator when it is primarily a utilization measure.
**Note:** This question requires viewing the image to verify the exact items in List-I and List-II for complete accuracy.
General Surgery Principles Indian Medical PG Question 4: Which of the following are stages of damage control surgery?
1. Patient selection
2. Control of haemorrhage
3. Resuscitation in ICU
4. Preventive surgery
Select the correct answer using the code given below.
- A. 1, 3 and 4
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3 (Correct Answer)
General Surgery Principles Explanation: ***1, 2 and 3***
- **Damage control surgery** (DCS) is a multi-stage approach for critically injured patients, involving initial stabilization, followed by definitive repair.
- The stages include **patient selection** (for those who would benefit), **initial hemorrhage and contamination control**, and subsequent **resuscitation in the ICU** before a final operation.
*1, 3 and 4*
- This option incorrectly includes **preventive surgery** as a stage of damage control surgery.
- While patient selection and ICU resuscitation are crucial, preventive surgery is not a distinct stage within the standard damage control protocol, which focuses on immediate life-saving measures and delayed definitive repair.
*1, 2 and 4*
- This option incorrectly includes **preventive surgery** and omits **resuscitation in the ICU**, which is a critical phase of damage control.
- After initial surgical control of bleeding and contamination, the patient undergoes aggressive resuscitation and optimization in the ICU before the next surgical stage.
*2, 3 and 4*
- This option omits **patient selection**, which is the crucial first step in determining who is a candidate for damage control surgery.
- It also incorrectly includes **preventive surgery**, as outlined previously.
General Surgery Principles Indian Medical PG Question 5: Which of the following statements about the management of haematomas is NOT correct?
- A. Haematoma must be operated. (Correct Answer)
- B. Some haematomas require surgical intervention.
- C. GCS assessment is helpful in prognosis.
- D. CT scan is the investigation of choice for acute haemorrhage.
General Surgery Principles Explanation: ***Haematoma must be operated.***
- This statement is **incorrect** because not all hematomas require surgical intervention.
- The decision to operate depends on **size**, **location**, **neurological status**, **mass effect**, and rate of expansion.
- Small, asymptomatic hematomas can be managed **conservatively** with serial imaging and close neurological monitoring.
- Absolute statements like "must be operated" are incorrect in clinical practice where individualized management is essential.
*Some haematomas require surgical intervention.*
- This statement is **correct** - many hematomas necessitate surgical evacuation.
- Indications for surgery include: **significant mass effect**, **midline shift >5mm**, **neurological deterioration**, **large volume** (>30mL for SDH, >50mL for ICH), or **posterior fossa hematomas** causing brainstem compression.
- Surgical intervention aims to relieve intracranial pressure and prevent secondary brain injury.
*GCS assessment is helpful in prognosis.*
- This statement is **correct** - the **Glasgow Coma Scale (GCS)** is a critical prognostic tool.
- GCS is used to assess severity of neurological injury and predict outcomes in head trauma patients.
- Lower GCS scores (≤8) indicate severe injury with poorer prognosis, while higher scores suggest better outcomes.
- GCS also guides management decisions including need for intubation and intensive monitoring.
*CT scan is the investigation of choice for acute haemorrhage.*
- This statement is **correct** - **Non-contrast CT (NCCT)** is the gold standard for acute intracranial hemorrhage.
- CT is rapid, widely available, and highly sensitive for detecting acute blood.
- It helps identify location, size, mass effect, and associated injuries like skull fractures.
- MRI has limited role in acute settings but is useful for subacute/chronic hemorrhage and detecting diffuse axonal injury.
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