Free NEET PG & INI-CET General Surgery MCQs

Explanation

Type III collagen predominates early in wound healing and is gradually replaced by stronger type I collagen during the maturation phase. This remodelling increases tensile strength over weeks to months.

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A clean-contaminated wound involves entering a hollow viscus — respiratory, gastrointestinal or genitourinary — under controlled conditions without significant spillage. Clean wounds enter no viscus, while contaminated and dirty wounds involve spillage or established infection.

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Isotonic crystalloids such as Ringer lactate or normal saline are first-line for resuscitating hypovolaemia, as they expand the intravascular volume effectively and are readily available. Blood products are reserved for haemorrhagic shock with ongoing blood loss.

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Polyglactin, or Vicryl, is a synthetic absorbable suture broken down by hydrolysis over weeks. Silk, polypropylene and nylon are non-absorbable. Absorbable sutures are chosen where permanent support is not required.

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Cool, clammy skin with tachycardia, hypotension and a low JVP indicates hypovolaemic shock from blood loss. Cardiogenic shock shows a raised JVP, septic shock is typically warm and vasodilated early, and neurogenic shock shows bradycardia with warm skin.

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ATLS follows the ABCDE sequence, and airway with cervical spine protection is the first priority. A blocked airway kills fastest, so it is secured before breathing, circulation, disability and exposure are addressed.

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This is a tension pneumothorax, a clinical diagnosis requiring immediate needle decompression or finger thoracostomy, followed by a chest drain. Do not delay for imaging — it is life-threatening and treated on clinical grounds.

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FAST is a rapid bedside ultrasound to detect free intraperitoneal fluid in an unstable trauma patient. A positive FAST in an unstable patient mandates urgent laparotomy, while CT is reserved for stable patients.

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The Parkland formula gives 4 mL of Ringer lactate multiplied by body weight in kg and by the percentage of total body surface area burned over 24 hours, with half given in the first 8 hours. Urine output guides adjustment; the formula estimates only the starting requirement.

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McBurney's point lies one-third of the distance from the anterior superior iliac spine to the umbilicus and marks maximal tenderness in acute appendicitis. Rovsing's sign, pain in the right iliac fossa on left-sided palpation, is a separate finding.

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Post-operative adhesions are the most common cause of small bowel obstruction in adults with previous abdominal surgery. Hernias are the leading cause in patients without prior surgery.

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Sudden severe pain with a board-like rigid abdomen and free sub-diaphragmatic gas, or pneumoperitoneum, indicates a perforated peptic ulcer. It requires resuscitation and urgent surgical repair.

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An indirect inguinal hernia passes through the deep ring, lateral to the inferior epigastric vessels, following the inguinal canal. A direct hernia protrudes medial to these vessels through Hesselbach's triangle.

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A tense, tender, irreducible hernia with bowel obstruction signals strangulation, where the blood supply to the contents is compromised. This is a surgical emergency requiring urgent operation to prevent bowel necrosis.

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CEA is used to monitor for recurrence after colorectal cancer resection, and a rising post-operative level suggests recurrence. It is not a screening test. CA 19-9 relates to pancreatic cancer, AFP to hepatocellular and germ-cell tumours, and CA 125 to ovarian cancer.

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An anal fissure causes severe pain on defecation with bright red bleeding and often a sentinel tag, typically in the posterior midline. Internal haemorrhoids are usually painless. Management ranges from stool softeners and topical agents to sphincterotomy.

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Murphy's sign is inspiratory arrest during right-upper-quadrant palpation, characteristic of acute cholecystitis. Cullen's and Grey Turner's signs relate to haemorrhagic pancreatitis, and Rovsing's to appendicitis.

Explanation

Charcot's triad — fever with rigors, jaundice and right upper quadrant pain — indicates ascending cholangitis. Adding hypotension and confusion gives Reynolds' pentad, a sign of severe suppurative cholangitis needing urgent biliary drainage.

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Courvoisier's law holds that a palpable, non-tender gallbladder with painless jaundice is unlikely to be due to gallstones, because chronic stone disease scars and shrinks the gallbladder. It points instead to malignant obstruction, such as pancreatic head cancer.

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Gallstones and alcohol account for the majority of acute pancreatitis cases. Other causes include hypertriglyceridaemia, hypercalcaemia, ERCP, trauma and drugs, but these are far less common.

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Triple assessment combines clinical examination, imaging by mammography and ultrasound, and pathology by FNAC or core biopsy. Using all three maximises diagnostic accuracy for a breast lump.

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The sentinel lymph node is the first node draining a tumour. Sentinel node biopsy determines whether cancer has spread to the axilla and guides whether full axillary clearance is needed, sparing many patients an unnecessary dissection.

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Recurrent laryngeal nerve injury causes hoarseness when unilateral, or airway compromise when bilateral, after thyroidectomy. External laryngeal nerve injury instead affects voice pitch and projection by weakening the cricothyroid muscle.

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Inadvertent removal or devascularisation of the parathyroid glands during total thyroidectomy causes hypocalcaemia, producing perioral tingling, carpopedal spasm and positive Chvostek and Trousseau signs. Treatment is calcium and vitamin D replacement.

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In TNM staging, T describes the primary tumour, N regional lymph node involvement and M distant metastasis. It is the standard framework for staging solid cancers and guiding treatment and prognosis.

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Breslow thickness, the depth of tumour invasion in millimetres, is the single most important prognostic factor in melanoma, guiding excision margins and the need for sentinel node biopsy. Greater thickness carries a worse prognosis.

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A pulsatile, expansile abdominal mass with sudden back or abdominal pain and hypotension indicates a ruptured abdominal aortic aneurysm, a surgical emergency. Immediate resuscitation and urgent repair are required, as delay is often fatal.

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The 6 Ps of acute limb ischaemia are pain, pallor, pulselessness, paraesthesia, paralysis and perishing cold, or poikilothermia. Paralysis and paraesthesia are late, ominous signs indicating a threatened limb needing urgent revascularisation.

Explanation

Non-contrast CT KUB is the investigation of choice for suspected urinary tract stones, with high sensitivity and specificity, and it detects radiolucent stones missed on plain films. Ultrasound is an alternative where radiation is a concern, such as in pregnancy.

Explanation

Sudden severe testicular pain with a high-riding testis and absent cremasteric reflex indicates testicular torsion, a surgical emergency. Exploration and detorsion must occur within about six hours to save the testis, and imaging should not delay surgery when suspicion is high.