General Surgery

NEET, DNB questions from general surgery

Shock

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Clinical Vignette MCQ | mcqsurgery.com

Clinical vignette

Practice | Clinical scenario

Q) A 25-year-old male is brought to the emergency department after a high-speed motorbike accident. He is conscious but reports inability to move his lower limbs. On examination his blood pressure is 75/40 mmHg, pulse 48/min, skin warm and dry. There is flaccid paralysis of both lower limbs and decreased sensation below the level of the umbilicus. Jugular venous pressure is low. What is the most likely diagnosis?
  • a) Hypovolemic shock due to occult intra-abdominal bleed
  • b) Neurogenic shock due to spinal cord injury
  • c) Cardiogenic shock due to blunt cardiac contusion
  • d) Septic shock due to aspiration pneumonia

Answer: b) Neurogenic shock due to spinal cord injury

Explanation: The classic triad in neurogenic shock is hypotension, warm dry skin (due to peripheral vasodilatation) and relative bradycardia resulting from loss of sympathetic tone with unopposed vagal activity. The history of acute spinal cord injury (inability to move lower limbs with sensory level) strongly supports spinal shock with sympathetic disruption. Low JVP argues against cardiogenic causes; hypovolemia typically causes tachycardia and cold, clammy skin; septic shock is unlikely immediately post-trauma and usually causes tachycardia. Initial management includes cervical spine immobilization (if relevant), airway protection, judicious IV fluids, and vasopressors (norepinephrine) for persistent hypotension—atropine may be required for severe bradycardia. Consideration for definitive spinal stabilization and early neuro-monitoring is essential.

Key points: loss of sympathetic tone → decreased systemic vascular resistance; bradycardia is characteristic; treat with vasopressors and supportive care.

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Published: Sept 6, 2025 • Tags: clinical vignette, spinal cord injury, distributive shock

Ulcerogenic cause of hypergastrinemia

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Free MCQ with CSS Toggle
Q) A 42-year-old male presents with multiple recurrent duodenal ulcers, abdominal pain, and chronic diarrhea. Fasting serum gastrin levels are >1000 pg/mL. Which of the following is the most likely ulcerogenic cause of hypergastrinemia?
✅ Answer: B. Zollinger–Ellison syndrome

🔍 Explanation:
Zollinger–Ellison syndrome (ZES) is caused by a gastrinoma (a gastrin-secreting tumor), typically located in the pancreas or duodenum.

It leads to massive hypergastrinemia, increased gastric acid secretion, and multiple, recurrent, or atypical peptic ulcers.

Diarrhea and steatorrhea are common due to acid inactivation of pancreatic enzymes.

Other Options:
A. Atrophic gastritis:
Leads to hypochlorhydria/achlorhydria with secondary hypergastrinemia, but non-ulcerogenic (low acid state).

C. Chronic PPI use:
Causes compensatory hypergastrinemia due to acid suppression, but again non-ulcerogenic unless stopped abruptly in predisposed individuals.

D. Helicobacter pylori infection:
May increase gastrin levels mildly, but ulcers are primarily due to mucosal damage and inflammation, not from gastrin hypersecretion.

🧠 Key Point: Zollinger–Ellison syndrome is the only ulcerogenic cause of hypergastrinemia. Fasting gastrin >1000 pg/mL with low gastric pH is diagnostic.

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Pericardial Injury

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Q: A 25-year-old male presents after a stab wound to the left 5th intercostal space at the midclavicular line.

He is hypotensive, tachycardic, and confused. eFAST reveals pericardial fluid. What is the next best step in management?

A. Pericardiocentesis
B. Emergency thoracotomy
C. CT angiography of the chest
D. Chest tube insertion

Suturing Techniques

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Q: During a surgical skills assessment, you are asked to perform a hand-sewn intestinal anastomosis using a continuous, inverting suture that enters the bowel lumen.

Which of the following suture techniques best fits this description?

#Theme from INI CET GI Mock test

A) Lembert suture
B) Cushing suture
C) Gambee suture
D) Connell suture
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H. Pylori Serology

Q: Which of the following is the primary reason why serology is not recommended for evaluating H. pylori treatment success?

# Stomach — INI GI Mock Test

A) Serological tests are less sensitive than stool antigen and urea breath tests.
B) Antibody levels can remain elevated for months to years after infection is eradicated.
C) Serological tests lack the ability to detect IgG antibodies accurately.
D) Serology tests have a specificity of less than 50%.
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Distributive Shock

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Q) What is not seen in Distributive Shock?

a) High central venous pressure

b) High Cardiac output

c) High Base deficit

d) High Mixed Venous Saturation

MCQs on Shock and Body Response 

Ans a 

In Distributive shock Systemic vascular resistance and venous pressure are low ( because of vasodilation)

All other parameters are high

Distributive Shock Symptoms

Vasodilation

Warm peripheries

Hypotension

Causes of Distributive Shock are

  1. Anaphylaxis
  2. High spinal cord injury
  3. Septic shock
  4. Toxic Shock Syndrome
  5. The distributive shock from adrenal insufficiency occurs due to decreased alpha-1 receptor expression on arterioles secondary to cortisol deficiency, which results in vasodilation. This is seen in patients on chronic steroids that are stopped suddenly.