Wounds and Surgical Infection — Practice Questions
Surgery — Wounds and Surgical Infection, NMC MBBS licence examination syllabus (Nepal Medical Council).
Wounds and surgical infection — NMC-style practice questions
Practice questions written for this chapter. These are not past NMC papers.
📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter.
Level 1–2 — recall and understanding
Q1. Prophylactic antibiotics for surgery should be given:
A. BEFORE the skin incision
B. Immediately after the operation
C. For five days after surgery
D. Only if the wound looks contaminated
ANSWER: A — before the incision.
Why: adequate tissue concentrations must be present at the
moment contamination occurs. Given afterwards, prophylaxis
achieves little, because bacteria are already established.
LEARNING POINT: prophylaxis is also SHORT — prolonging it adds
resistance and side effects, not protection.
Q2. A deep, soil-contaminated laceration with devitalised
tissue should be managed by:
A. Immediate primary suturing for a neat scar
B. Cleaning, DEBRIDEMENT and leaving the wound open
C. Antibiotics alone with no wound care
D. Dressing without cleaning
ANSWER: B.
Why: closing a contaminated wound over dead tissue seals
bacteria into an anaerobic space — an abscess waiting to
happen. Delayed closure is considered once the wound is clean.
Tetanus status must also be checked.
LEARNING POINT: never primarily close a contaminated wound.
Level 3–4 — application and clinical reasoning
Q3. A patient on five days of appropriate antibiotics still
has a swinging fever and a tender fluctuant swelling. The
correct next step is:
A. Change to a broader-spectrum antibiotic
B. DRAIN the collection
C. Continue the current antibiotic for longer
D. Add an antifungal
ANSWER: B — drainage.
Why: an abscess has no blood supply in its centre, so no
antibiotic reaches the pus. The partial response followed by a
plateau is the classic pattern of an undrained collection.
LEARNING POINT: if a patient is not improving on appropriate
antibiotics, look for a collection or dead tissue before
changing the drug.
Q4. A diabetic patient has severe leg pain out of proportion
to modest erythema, with tachycardia and systemic
toxicity. The correct action is:
A. Oral antibiotics and review in 48 hours
B. CT first, surgical opinion afterwards
C. IMMEDIATE surgical review for debridement
D. Elevation and observation
ANSWER: C.
Why: pain out of proportion to the visible findings, with
rapid progression and toxicity, is necrotising infection until
proven otherwise. The fascial plane is involved beneath
deceptively normal-looking skin.
LEARNING POINT: imaging must not delay theatre when the
diagnosis is clinically suspected.
Q5. A patient recovering well after bowel surgery develops
fever, tachycardia and abdominal pain on day 6. The most
important diagnosis to exclude is:
A. Postoperative ileus
B. ANASTOMOTIC LEAK
C. Atelectasis
D. Urinary tract infection
ANSWER: B — anastomotic leak.
Why: deterioration AFTER initial improvement, at this timing,
following an anastomosis, is a leak until proven otherwise.
Ileus does not usually cause fever and progressive systemic
upset.
LEARNING POINT: attributing a leak to ileus loses critical
time.
Level 5 — exception-based
Q6. Why do antibiotics fail to sterilise an abscess?
A. Bacteria in pus are always resistant
B. There is no blood supply within the collection, so the
drug cannot reach the centre
C. Antibiotics are inactivated by blood
D. Abscesses are usually viral
ANSWER: B.
Why: antibiotics reach tissue through the circulation, and an
abscess cavity is avascular. The acidic anaerobic environment
also impairs several antibiotic classes and neutrophil
function.
LEARNING POINT: source control is the treatment; antibiotics
are the adjunct.
Q7. A pink serous discharge from an abdominal wound around
day 7 should raise concern about:
A. Normal healing
B. Impending WOUND DEHISCENCE
C. Urinary leak
D. Allergy to sutures
ANSWER: B — impending dehiscence.
Why: serous discharge may precede separation of the wound.
Burst abdomen is a surgical emergency: cover the viscera with
warm saline-soaked swabs, resuscitate and return to theatre.
LEARNING POINT: a warning sign is only useful if acted upon.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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