AMC MCQ General Surgery Principles 3 — Questions and Answers
Question 1: A patient develops a wound dehiscence on day 7 with a 'pink serosanguinous discharge' preceding it. What is the next step?
- Cover with saline gauze and return to theatre for resuture (Correct answer)
- Discharge home with reassurance
- Apply a tight adhesive dressing only
- Start oral antibiotics and observe
Correct answer: Cover with saline gauze and return to theatre for resuture
Serosanguinous discharge heralds fascial dehiscence, which requires theatre resuture after a moist sterile dressing.
Question 2: Which classification grades surgical complications by the therapy required to treat them?
- Clavien-Dindo classification (Correct answer)
- ASA classification
- TNM classification
- Glasgow score
Correct answer: Clavien-Dindo classification
The Clavien-Dindo system grades postoperative complications according to the intervention needed.
Question 3: What is the most appropriate initial fluid for resuscitating a hypovolaemic surgical patient?
- Balanced crystalloid such as Hartmann's solution (Correct answer)
- 5% dextrose
- Hypertonic saline 3%
- Packed red cells immediately in all cases
Correct answer: Balanced crystalloid such as Hartmann's solution
Balanced crystalloids are first-line for restoring intravascular volume in hypovolaemia.
Question 4: A diabetic patient has a HbA1c of 9.5% before elective hernia repair. What is the best action?
- Defer surgery to optimise glycaemic control (Correct answer)
- Proceed immediately regardless
- Cancel surgery permanently
- Double the insulin only on the operative morning
Correct answer: Defer surgery to optimise glycaemic control
Poor glycaemic control raises infection and wound risk, so elective surgery should be deferred for optimisation.
Question 5: Which of these is an absolute indication for blood transfusion intraoperatively?
- Symptomatic anaemia with ongoing haemorrhage and hypoxia (Correct answer)
- Haemoglobin of 110 g/L in a stable patient
- Patient anxiety
- Routine for all major operations
Correct answer: Symptomatic anaemia with ongoing haemorrhage and hypoxia
Transfusion is indicated for symptomatic anaemia with active bleeding and inadequate oxygen delivery.
Question 6: What is the recommended first-line management of a small, stable, postoperative seroma?
- Observation as most resolve spontaneously (Correct answer)
- Immediate surgical exploration
- High-dose IV antibiotics
- Pressurised irrigation
Correct answer: Observation as most resolve spontaneously
Most small seromas reabsorb spontaneously and need only observation.
Question 7: In the WHO surgical safety checklist, when is the 'time out' performed?
- Before skin incision (Correct answer)
- After the patient leaves theatre
- During sign-in only
- Only if a complication occurs
Correct answer: Before skin incision
The 'time out' occurs immediately before incision to confirm patient, site and procedure.
AMC MCQ General Surgery Principles 3
A patient develops a wound dehiscence on day 7 with a 'pink serosanguinous discharge' preceding it.
What is the next step?