FRCS Principles of Surgery & Wound Healing 2

Question 1

Which organism is the most common cause of wound infection in colorectal surgery?

Accepted Answer

Bacteroides fragilis

Answer

Bacteroides fragilis is the most common organism isolated in post-operative wound infections following colorectal surgery. It is a Gram-negative anaerobe from the colonic flora. Broad-spectrum prophylaxis (e.g., metronidazole plus cephalosporin) covers both aerobic and anaerobic bowel flora.

Question 2

In a patient with a large ventral hernia, which mesh position has the lowest recurrence rate?

Accepted Answer

Retromuscular (Rives-Stoppa: posterior to rectus muscle, preperitoneal)

Answer

The retromuscular (Rives-Stoppa) technique, placing mesh posterior to the rectus muscle in the retromuscular plane, achieves the lowest recurrence rates for complex ventral hernias. The mesh is held in place by intra-abdominal pressure and avoids direct bowel contact, reducing adhesion risk.

Question 3

What is the Principles of ERAS (Enhanced Recovery After Surgery) protocol aimed at?

Accepted Answer

Reducing the physiological stress of surgery by perioperative optimisation to accelerate return of function

Answer

ERAS (Enhanced Recovery After Surgery) protocols use multimodal evidence-based perioperative care pathways — including preoperative carbohydrate loading, minimal bowel prep, regional anaesthesia, early mobilisation, early oral intake, and avoidance of drains/NG tubes — to reduce the metabolic stress response and accelerate recovery.

Question 4

A patient post-thyroidectomy develops perioral tingling and muscle cramps. Which complication has occurred?

Accepted Answer

Hypocalcaemia from hypoparathyroidism

Answer

Post-thyroidectomy hypocalcaemia results from inadvertent removal or devascularisation of the parathyroid glands during surgery, causing hypoparathyroidism. Symptoms include perioral and digital tingling (paraesthesiae), carpopedal spasm (Trousseau's sign), Chvostek's sign, and eventually tetany or seizures.

Question 5

Which type of wound closure is most appropriate for a severely contaminated wound from a perforated bowel?

Accepted Answer

Delayed primary closure (closure at 4–5 days if no infection)

Answer

Contaminated or dirty wounds (e.g., from perforated bowel, faecal contamination) should not be closed primarily due to the high risk of wound infection and dehiscence. Delayed primary closure (at 4–5 days) allows the wound to be cleaned and monitored before closure when infection risk has reduced.

FRCS Part A Practice Test

FRCS Part A Practice Test

FRCS Principles of Surgery & Wound Healing 2