RAPID REVISION COURSE

Module – 7
GENERAL SURGERY

Prepared BY:

Dr. Sandeep Singh

AIR-1 2020
Vet Science
INTRODUCTION

TYPES OF SURGERY

Radical surgery (ICAR 2019) Eliminate root cause

Reconstructive surgery (ICAR 2020) The correction of

deformities/malformations

Conservative surgery (KPSC VS-2017) To preserve or restore a disabled part

Restorative surgery (HPPSC VO-2021) To restore the normal function of body or a

part without substituting or replacing
Exploratory surgery (LDO-2011) The confirmation of a diagnosis [LDO2011]
To arrive at a diagnosis or for confirmation
of a disease (TNPSC AHVS2019]

Elective surgery(PPSC VO-2019) Ovariohysterectomy /Mastectomy in bitch/

Docking in 10 day old dog

Based on Urgency

Elective Performed upon the Neutering/spaying

client’s request
(non-life threatening)
Semi-Elective Performed to avoid Dislocation/Dysplasia
permanent disability or
death
Emergent Performed ASAP Tracheostomy
To save a life, limb or an
animal’s functional
capacity
Based on Purpose/Goal

Diagnostic Performed to aid or confirm Exploratory surgery

a medical diagnosis
Therapeutic Performed to
treat/potentially treat a
condition
Cosmetic Performed to “improve” the Tail docking/ear cropping
morphological appearance
of an animal
 Based on TECHNIQUE

Excision Removal or ‘cutting out’ of a body part

Resection Removal of an internal organ or a part of
organ
Reconstruction Repair of an injured or deformed body part
(congenital anomalies ex:- cleft palate)
Implantation Placement of a medical device to replace a
missing biological structure, enhance an
existing one or to support a demaged one.
Replantation Reattachment of a severed body part
Transplantation Replacement of an anatomic structure with
another from another animal
Surgical Procedure Nomenclature

For Excision & Resection “ectomy” [splenectomy (spleen+ectomy)=removal

of the spleen]

For Excision & Resection “ation” Castration=removal of testis

Amputation =removal of a limb or a part
of,.
Enucleation =removal of an eye ball]
For opening body cavities “otomy” Celiotomy/Laprotomy = surgical opening
and hollow organs of the abdominal cavity
Thoracotomy (thoracic cavity)
Enterotomy,
Urocystotomy =surgical opening of the
UrinaryBladder [Uro=urinary,
Cyst=bladder , otomy =opening ]
Cholecystotomy = surgical opening of the
Gall Bladder
For creation of Semi- “ostomy” Tracheostomy=Creation of an artificial
/Permanent openings in a hole on the ventral aspect of the trachea
body part Urethrostomy=Creation of a permanent
hole in the urethra (common in Male
cats)
Esophagostomy =creation of a hole on
the cervical esophagus for feeding tube
placement
For minimally invasive “oscopy” Endoscopy=insertion of a scope through
imaging procedures (surgical insertion of a the mouth to visualize the esophageal
scope into the body for and gastric lumen
real time imaging) Laparoscopy = insertion of a scope
through the abdominal wall to visualize
 the abdominal cavity Bronchoscopy =
insertion of a scope through the mouth to
visualize the trachea & bronchi
Cystoscopy =insertion to the urethral
orifice to visualize the urinary bladder
For repair of damaged “rraphy” Herniorraphy=repair of a hernia
body part or congenital
anomaly
For reconstruction of a “plasty” Rhinoplasty=reconstruction of external
body part nares to allow better passage of air (BOAS
–pug)
For surgical fixation or “pexy” Gatropexy=Surgical fixation of the gastric
suspension pyloric antrum to the right abdominal
wall for prevention of gastric twisting
during bloat

TENETS/PRINCIPLES OF HALSTED
8 PRINCIPLES = GAACO SAI

G= Gentle handling of tissues

A= Aseptic technique
A= Anatomical dissection of tissue
C= Control of hemorrhage
O= Obliteration of dead space
S= Suture material (use minimum)
A= Avoidance of suture tension
I= Immobilization

Q. The correct statement regarding the Tenets of Halstead (1852-1922) is

[GPSC VO-2016/17]
a) It is not applicable to key hole laparoscopic surgery
b) It is not relevant to the present day surgery
c) It is most relevant and applicable to the present day surgery
d) None of the above
 SUTURE

Suture
Tissues have different requirements for suture support (to heal )
for only a few days - muscle, subcutaneous tissue, skin
for weeks - fascia
for months - tendon

Suture classification

based on :

 Absorbability – absorbable, Non- absorbable

 Origin – Natural/organic, Synthetic, Metallic
 Structure – Monofilament, Multifilament

SUTURE MATERIALS (Based on Absorbability)

Absorbable Non-absorbable
These sutures get absorbed in the tissues These sutures remain in the tissues for
either by enzymatic digestion or by indefinite period (>60 days)
phagocytosis (<60 days)
Natural/Organic Natural/Organic
Catgut (90% Collagen) Silk
Collagen Silkworm gut
Kangaroo tendon (collagen) Cotton
Fascia lata Linen
Cargile membrane Horse Hair

Synthetic Synthetic
Polyglactin 910 (Vicryl) Poly Amide (Nylon)
Poliglecaprone 25 (Monocryl) Ethilon ,Nurolon ,Dermalon ,Surgilon
Polyglycolic acid (PGA/Dexon) PolyButester (Novafil)
Polydioxanone (PDS II) Poly Caprolactam
Supramid, Vetafil
Poly Ester
Mersilene (uncoated),Ethibond (coated)
Dacron (uncoated) , Ticron (coated)
Poly Propylene
Prolene , Surgilene ,Fluorofil
Stainless steel wire , Aluminium wire
Umbilical tape
 SUTURE STRUCTURE

Characteristics Monofilament Multifilament

Number of strands 1 Multiple
Flexibility Low High
Surface Smooth Rough
Crevices/interstices Absent Present
Bacterial contamination None to low High
Capillary action None to low Moderate to High
Knot security Low (become loose) High (does not slip)
Drag Low High
Example (Absorbable) Polydioxanone (PDS II), Chromic Catgut , Vicryl,
Monocryl , polyglytone Polysorb, PGA(Dexon)
6211(Caprosyn)

Example (Non absorbable) Prolene, Novafil, Nylon Nylon(Surgilon/Nurolon),

(Ethilon/Dermalon), Horse Silk (Perma Hand),
hair Polyester, stainless steel
wire(Flexon), Polymerized
caprolactam (Supramid,
Vetafil)
Suture Characteristics

1. Size
2. Absorbability
3. Absorption rate
4. Capillarity [LDO-2014]
5. Tensile strength
6. Flexibility
7. Relative knot security
8. Memory
9. Surface characteristics

Size : The most commonly used standard for suture size is the USP, 12-0 the smallest & 7 the
largest
USP 12-0 11-0 10-0 9-0 8-0 7-0 6-0 5-0 4-0 3-0 2-0 0 1 2 3 4 5 6 7
Size
As the size increases, the strength of the suture increases

Size of the suture must match the strength of the tissue that you have to appose

Ex: fat (weakest tissue)<Muscles<Skin, Fascia, ligaments, tendons (strongest)

If you use :

a) Oversized suture – excessive tissue reaction, tissue strangulation – non closure,

infection
b) Undersized suture – poor wound apposition, no tension created – non closure, infection

Trade name : Monocryl Generic name : Poliglecaprone 25 Structure: Monofilament

Size: 4-0 (USP) , 1.5 metric(metric system) Length of suture: 18” (45 cm) length of needle
:13mm

ABSORBABILITY AND ABSORPTION RATE

ABSORBABILITY- ability of a suture to be broken down by the body and how quickly it is absorbed
 CAPILLARY ACTION

 Extent of fluid absorption of the suture material.

 Fluid and bacteria are carried into the interstices of multifilament fibers.
 All braided materials (e.g., polyglycolic acid, silk) have degrees of capillarity
Monofilament sutures are considered noncapillary
 Capillary suture materials should not be used in contaminated or infected sites.

Tensile Strength

Measure of the ability of a material to resist deformation and breakage

Flexibility – “Ease of Handling”

How bendable a suture is during tying and securing knots

Relative knot security -“ how strong the knot is”

Relative knot security is the holding capacity of a suture expressed as a percentage of its tensile strength

Relative amount of strength and pressure needed to untie or break a knot.

Memory

Inherent capability to maintain or return to its original shape after manipulation or deformation

Surface characteristics and Coating

 Suture surface affect the amount of friction (DRAG) that is generated due to contact between
the suture and tissue.
 Rough sutures cause more injury than smooth sutures.
 Smooth surfaces are particularly important in delicate tissues (the eye).
 Braided materials have more drag than monofilament sutures.
 Teflon, silicone, wax, paraffin-wax, and calcium stearate are used for coating sutures.

Q. For the ideal qualities of a sutures, which is not correct [LDO-2014]

i) Cause minimum tissue reaction
ii) More capillary in action
iii) Be knotable
iv) Have sufficient functional strength
a) ii b) iv c) iii d) i

Suture Removal
Usually within 10 to 14 days after surgery
Previous Year Questions (SUTURE MATERIAL & TECHNIQUES)

Absorbed most rapidly from an infected wound Catgut

through increased local phagocytic activity (ICAR
VS-2018)
Non-absorbable suture used for internal Silk
organ(ICAR VASIII2018)
Recurrence of rectal prolapsed is prevented Purse string suture
by(ICAR VASIII2018)
Suture pattern to close a stump (ICAR VS-2018) Parker kerr

Parkar-kerr suturing pattern is associated with Small intestine anastomosis

(MPPSC VAS2018)
Suture used to narrow and constrict lumen of Purse-string suture
hollow organ (MPPSC VAS2018)
Tendon suture (ICAR VS2020,ICAR VASIII2018,RPSC Bunnel
VO2019)
synthetic absorbable suture material(OPSC Vicryl
VAS2019)
Extra chromic catgut gets absorbed in (OPSC 40 days
VAS2018)
Eversion suture pattern [TNPSC AHVS-2019] Horizontal mattress, Vertical mattress
Buhner suture (RPSC VO2019) Vaginal prolapse in a cow

Commonly used Knot for temporary fastening for Over hand Knot, Square knot, Surgeon's Knot
surgical restraint (MPPSC VAS2018)
Lock stich suture (Mz PSC VO-2018) Hernial ring
Suture material is used to repair hernias or Surgical mesh
reinforce traumatized or devitalized tissue
Organic non-absorbable suture(TNPSC AHVS2019) Silk
Most widely used absorbable suture Chromic catgut
material in veterinary practice (GMC VO-
2016/17)
Suture size used for closure of skin in cow(PPSC No 2
VO-2019)
Double row of lambert suture(OPSC VAS2018) Czerny suture
TYPES OF SURGICAL KNOTS

Granny (Pseudo-square) Knot Square (Reef) Knot Surgeons Knot

• Consist of two throws • Consist of two throws • Consist of two throws
• Crossing does not occur in • Crossing is done in each • Two wraps in first
any throw throw throw• Crossing occurs
• Not a secured knot • Secured knot in each throw
Surgeon’s knot is more
secure than square knot

Q. Regarding surgical knots the correct statement is [GMC V0-2018]

a) Surgeon’s knot is more secure than square knot
b) Square knot is more secure than surgeon’s knot
c) Granny knot is more secure than square knot
d) Granny knot is more secure than surgeon’s knot

Q. What is surgical knot recommended for suture material that are likely to slip
[TNPSC AHVS-2019]
a) Square knot
b) Granny knot
c) Nylon knot
d) Half hitch knot
 WOUND MANAGEMENT

Wound – “any break in the skin or any layer of it”

Open Wound Closed Wound

Incision Hematoma

Laceration

Abrasion

Avulsion

Puncture

Incisional wounds

Full thickness wounds caused by clean, sharp-edged instrument like a scalpel blade running parallel to
the skin

Lacerations

- “irregular tear-like wounds” usually caused by TRAUMA

may be Superficial or Deep
Abrasion

“graze or scratch”

Superficial wounds affecting the EPIDERMAL layer ONLY

Commonly caused by sliding fall on a rough surface (cement, street, tree bark)

Avulsion

Wound wherein structures (skin/muscles) are traumatically detached from its normal attachments.

If only skin is involved = DEGLOVING

Punctured wounds

Wounds caused by an object or instrument puncturing the skin (Nail, glass, needle, splinters)

Hematomas

Closed wounds caused by demage to blood vessels which causes accumulation of blood on the
subcutaneous space. Ex: Aural hematomas, skin bruises after blunt force trauma

Q. The closed cavity filled with blood is known as [ICAR VS-2018]

a) Cyst
b) Haematoma
c) Abscess
d) sarcoma
Methods of Wound Healing
1. Primary intention
2. Secondary intention
3. Tertiary intention

Primary intention

- Healing of a clean wound with no tissue loss wherein wound edges are apposed with sutures,
staples or tissue adhesive. Ex : healing of surgical wounds
- Faster healing, Less scarring

Secondary intention

- Wound is left open when primary intention is impossible (wound edges too far, tissue
loss/demage) .
- We leave it open , we leave the wound to granulate, it will heal on its own
- Usually it leads to a bigger scar it will take a longer time
we usually do wound packing to facilitate healing
Tertiary intention

- Combination of primary and secondary

- Wound is purposefully left open for 4-5 days and eventually closed with sutures or other
biomaterials.
- Wound is initially cleaned, necrotic tissue debrided and once wound edges may be
approximated, is closed through primary healing

Ex: infected wounds with healthy vascularization

CLASSIFICATION OF SURGICAL WOUNDS

Classification Description Examples Infection Rate Indications for

Prophylactic
Antibiotics
Clean Nontraumatic, Exploratory 3% Not Indicated
(ICAR VASIII2019) noninflamed laparotomy
operative Elective neuter
wounds . Total hip
the respiratory, replacement
gastrointestinal, PDA
genitourinary, &
oropharyngeal
tracts are not
entered

Clean- the respiratory, Bronchoscopy Indicated

Contaminated gastrointestinal, Cholecystectomy 3.5%–4.5%
or genitourinary Small intestinal
tract is entered resection
under controlled Enterotomy
conditions Renal
without unusual transplantation
contamination;
an otherwise
clean wound in
which a drain is
placed

Contaminated Open, fresh, Bile spillage 4.6%–9.1% Indicated

accidental during
wounds; cholecystectomy
procedures in or biliary
which diversion
gastrointestinal procedures
contents or Open cardiac
infected urine is massage
spilled or a major Cystotomy with
break in aseptic spillage of
technique occurs infected urine
Lacerations
Dirty Old traumatic Excision or Prophylactic
wounds with drainage of an 6.7%–17.8% antibiotics are
purulent abscess, indicated + treated
discharge, Peritonitis , with antiseptics such
devitalized Perforated as 0.05%
 tissue, or foreign intestinal tract, chlorhexidine
bodies; Ruptured solution
procedures in gallbladder
which a viscus is caused by
perforated or necrotizing
fecal cholecystitis,
contamination Bullae osteotomy
occurs for otitis media

Clean Surgery (ICAR VASIII 2019] Exploratory laparotomy , Elective neuter

Total hip replacement , PDA
Contaminated surgery Bronchoscopy , Cholecystectomy
Small intestinal resection , Enterotomy
Renal transplantation
Clean Contaminated surgery Bile spillage during cholecystectomy or
biliary diversion procedures , Open cardiac
massage
Cystotomy with spillage of infected urine,
Lacerations
Dirty Surgery Excision or drainage of an abscess
Peritonitis , Perforated intestinal tract
Ruptured gallbladder caused by
necrotizing cholecystitis , Bullae osteotomy
for otitis media

Previous Year MCQs on WOUND

1. A closed wound which is produced by blunt objects results in demage to subcutaneous tissues
without break in continuity of the skin surface is [TNPSC VAS-2020]
a) Bruise
b) Contusion
c) Haematoma
d) Seroma
2. Which of the following describes a wound healing achieved by secondary sutures
[TNPSC AHVS-2019]
a) First intention healing
b) Second intention healing
c) Mixed intention healing
d) Third intention healing
3. The type of wound healing in which granulation tissue forms, filling the defect, is known as
[PPSC VO-2019]
a) First intention
b) Second intention
c) Third intention
d) Fourth intention
4. Wound that is showing tendancy to heal is [ICAR VAS-III 2018]
a) Healing wound
b) Proud flesh
c) Granulating wound
d) Aseptic wound
5. Wound which does not heal is known as [MzPSC VO-2019]
a) Maggot wound
b) Ulcer
c) Infected wound
d) Contaminated wound
6. Last stage of wound healing is [MzPSC VO-2019]
a) Wound contraction
b) Epithelization
c) Fibroplasia
d) Vasodilatation
7. The enzyme used for debridement of a wound [PPSC VO-2019]
a) Bacterial collagenase
b) Bacterial protease
c) Bacterial lipase
d) Reverse transcriptase
8. A typical granulation tissue at the early stages of development exhibits following features
[OPSC VAS-2019/20]
a) Presence of giant cells
b) Presence of mature connective tissue
c) Marked angiogenesis and fibroblasts
d) Presence of collagen
9. Abnormal large amount of granulation tissue is known as [RPSC VO-2019]
a) Callus
b) Adenoma
c) Proud flesh
 d) Sarcoma
10. The wounds of more than 6 to 8 hours duration are designated as [LDO-2012]
a) Contaminated wound
b) Infected wound
c) Maggoted wound
d) Surgical wound
11. The wound is known as infected if the bacterial count exceeds
[ICAR VASIII-2017,ICAR VS-2020]
a) 105 bacteria/gm
b) 106 bacteria/gm
c) 108 bacteria/gm
d) 107 bacteria/gm
12. Which phase of wound healing extends upto months or years [HPPSC VO-2017]
a) Hemostasis
b) Proliferative phase
c) Remodeling phase
d) None of these
13. In which stage of wound healing, centripetal movement of the whole thickness of the
surrounding skin appears [TNPSC AHVS-2019]
a) Inflammatory
b) Wound contraction
c) Wound maturation
d) Epithelialization
14. Hydrogen peroxide (3%) liberates nascent oxygen by which one of the following present at the
surface of a wound or mucous membrane [ICAR VASIII-2020]
a) Catalase
b) Hyaluronidase
c) Peroxidase
d) Glucuronidase
Coagulation Cascade - 2°Hemostasis

Intrinsic Extrinsic

12

11 3 (Third Factor , T.F=Tissue Factor)

TRICK
❾ ❼ 12.00
11.98
8 10.00 = (3+7)
❿ Common 5.00
2.00
5 1.00

1 (Fibrinogen) Fibrin

Hemostatic techniques

1. Ligation (Ideal method)

2. Pressure hemostatis
3. Hemostatic forceps
4. Topical hemostatic agents
5. Energy-Based Hemostasis (Electrocautery/ Electrosurgery/Diathermy)
6. Others – adrenaline, vit-K, Ca, Ice, Torniquet, Plugging/Packing (Tampon), Tr.Benzoin

Indication of each method depends upon:

Size of vessel Larger vessels must be ligated.

Double ligatures are recommended for
larger vessels, particularly arteries.
Electrosurgery- hemostasis for vessels <1.5
to 2 mm
Nature of vessel Artery / Vein/Capillary
Topical Hemostatic Agents

Bone wax sterile mixture of beeswax, paraffin & isopropyl palmitate.

It is pressed into bleeding channels of bone to control hemorrhage through a
TAMPONADE EFFECT.
Nonabsorbable so must be used sparingly
May act as a foreign body, interfere with bacterial clearance and become a nidus
for infection.
Use: spinal surgery
Avitene Microfibrillar collagen derived from bovine skin
Absorbable
Gel foam Absorbable gelatin sponge which provides a physical matrix that initiate clotting
(Gelatin- through contact activation.
based) High absorption makes it swell and exert pressure on the wound
Should NOT be left in infected sites wherein it acts as a nidus and exert
unnecessary pressure on neighboring vital structures.
Other gelatin-based hemostatics - SurgiFlow Hemostatic Matrix and Vetspon.
Surgicel Oxidized regenerated cellulose.
(Cellulose- Absorbable ( must be removed after placement because it may inhibit callus
based ) formation & promote infection)
After blood absorption, it becomes a gelatinous mass which is a substrate for clot
formation.
It is NOT activated by tissue fluids other than blood, s/b used only at sites of
hemorrhage.
Energy-Based Hemostasis

Electrocautery Coagulates small vessels or cuts tissue by using heat generated by direct
electric current into a metal wire or probe.
Electrical current does not enter the patient’s body.
Electrosurgery Generate heat inside the tissue using an alternating electric current that
passes through the tissue creating a circuit.
used for hemostasis for vessels less than 1.5 to 2 mm diameter
Monopolar Electrosurgery, Bipolar Electrosurgery
Monopolar electrosurgery = the most commonly used method
Bipolar is used when precise coagulation is necessary and to prevent
damage to adjacent structures(spinal surgery, thyroidectomy, or ophthalmic

Vessel Electrothermal, feedback-controlled, bipolar vessel sealing systems

Sealing(Ligasure) Can permanently seal blood vessels up to 7 mm in diameter.
The device uses pressure and pulsed, low voltage energy to fuse collagen
and elastin of the vessel wall and achieve hemostasis.
Use : laparoscopic (ovariectomy/cryptorchidectomy) surgery
thoracoscopic (partial pericardectomy/lung lobectomy)
 open abdominal procedures (splenectomy, liver lobectomy)
upper airway surgery (soft palate resection, tonsillectomy)

Previous Year Questions (Hemostasis)

Temponade plugging can be employed to Cavities

control bleeding from [ICAR VASIII-2017]
Cauterization of vessels by mono-polar and Diathermy
bipolar coagulation is called [MzPSC VO-2019]
To hold the artery and prevent Artery forceps
bleeding(DSSSB –LI 2021)
the use of the artery forceps (DSSSB –LI 2021) To check the bleeding by pressing artery
at the time of operation
BIOMATERIALS

Tissue Adhesives Tissue adhesives rapidly polymerize in the presence of moisture and
(Tissue Glue) produce a strong, flexible bond.
Only indicated for Superficial, Clean wounds(<5cm)
cause an intense inflammatory reaction within subcutaneous tissue
(Granuloma formation)
Adhesives should not be used on bite wounds, severely contaminated
wounds, ulcers, deep wounds, puncture wounds
Cyanoacrylates are commonly used.

Skin Staples Rapid and precise wound closure

Provides good skin closure and a degree of tissue eversion that is favorable
for wound healing.
made of 316 L stainless steel
Surgical Mesh Used to repair hernias or reinforce traumatized or devitalized tissue.
nonabsorbable forms (polyester, Prolene mesh) or absorbable forms (Vicryl)
Polypropylene mesh facilitate the reconstruction of large tissue defects in
small animals without serious complications.
Generally elastic but does not stretch well when placed in young animals as
it grows

Q. What suture material is used to repair hernias or reinforce traumatized or devitalized

tissue [TNPSC AHVS-2019]
a) Staples
b) Autologous fibrin glue
c) Surgical mesh
d) Tissue adhesives
Principles of Surgical Asepsis

WE CANNOT RENDER A LIVING THING STERILE

BASIC TERMS

Asepsis Absence of microorganisms that cause disease.

Aseptic technique Method to prevent contamination by microorganisms.

Antisepsis Prevention of sepsis by exclusion, destruction, or inhibition of growth or

multiplication of microorganisms from body tissues and fluids.
Antiseptics Inorganic chemical compounds that combat sepsis by inhibiting growth of
microorganisms without necessarily killing them. Used primarily on skin to stop the growth of
resident flora.

Disinfection Chemical or mechanical (friction) destruction of pathogens.

Sterile Free of living organisms.

Sterile field Area around the site of incision into tissue or the site of introduction of an
instrument into a body orifice that has been prepared using sterile supplies and equipment.
Sterile technique Method by which contamination with microorganisms is prevented to
maintain sterility throughout the surgical procedure.
Terminal sterilization: Procedures carried out for the destruction of pathogens at the end of
the surgical procedure in the operating room after the patient has been removed.

7 General principles of aseptic technique

1. Use only sterile items within a sterile field
2. Sterile (scrubbed) personnel are gowned and gloved
3. Sterile personnel operate within a sterile field (sterile personnel touch only sterile items
or areas, unsterile personnel touch only unsterile items or areas);
4. Sterile drapes are used to create a sterile field
5. All items used in a sterile field must be sterile
6. All items introduced onto a sterile field should be opened, dispensed, and transferred by
methods that maintain sterility and integrity
7. A sterile field should be maintained and monitored constantly; and (8) surgical staff
should be trained to recognize when they have broken technique and should know how
to remedy the situation.

Definition Sterilization/Disinfection Examples

Critical items Equipment or implants Requires sterilization Implants
entering sterile tissue of Catheters
the vascular system Surgical instruments
Laparoscopes
Suture material
Biopsy forceps
Arthroscopes
Semi-critical items Equipment that does Requires high-level Vaginoscopes
not penetrate the body; Colonoscopes
they contact the skin or
disinfection Flexible endoscopesa
mucous membranes Some dental
only instruments
Endotracheal tubes
Non-critical items Instruments that contact Require Low-level Laryngoscopes
the mucous membranes Ultrasound probes not
disinfection
or intact skin not directly used in the body
associated with surgery Blood pressure cuffs
ECG leads
Pulse oximeters
Stethoscopes
STERILIZATION
1. Physical
- Thermal – Dry heat and Moist heat
- Filtration : for heat labile solutions
- Radiation : gamma rays for disposable articles, Chromic cat gut

2. Chemical
- Solutions : Alcohol and Aldehyde
- Gases (Ethylene oxide) [ICAR

DRY HEAT STERILIZATION : HOT AIR OVEN TIME-TEMPERATURE Combination for

Dry heat sterilization
- MOA : Oxidation
- Used for : Oil, powder , glass surgical 120°C- 8 hours
- Hot Air Oven = 160°C for 60 minutes 140°C- 2.5 hours
160°C- 1 hour [HOT AIR OVEN]
170°C- 40 min
MOIST HEAT/STEAM STERILIZATION : AUTOCLAVE

- Most commonly used method

- Saturated steam under pressure is a practical and dependable agent for sterilization
of heat-tolerant medical supplies and packaging.
- MOA = Coagulation / Denaturation of cellular proteins
- Autoclave = 121°C 15 minutes 15 lbs
- Used for = Surgical instruments (ICAR VS-2018)
- Biological indicator = Bacillus stearothermophilus [ICAR VASIII-2017]

Types of Steam Sterilizers

- Gravity Displacement Sterilization : most commonly used steam sterilizer in veterinary

- Prevacuum Sterilization : 131°C (270°F) for 3 minues
- Immediate-use, emergency, or “flash” sterilization
Chemical (Gas) Sterilization
Ethylene Oxide

- Flammable, explosive gas

- MOA : alkylation of proteins, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA)
- Sterilization depends on : the concentration of EtO(600mg/L), the humidity level (40%),
the temperature, and the volume, density, and types of materials to be sterilized.
- Most items are sterilized at 54.4°C (130°F) for 2.5 hours
- Heat-sensitive items are sterilized at 37.8°C (100°F) for 5 hours.
- The most common veterinary units run on 12- and 24-hour cycles and operate at room
temperature.
- Biological indicator = Bacillus subtilis

Cold Sterilization
- Use of liquid chemicals for sterilization of equipment which are heat-sensitive
- 2% Glutaraldehyde : a high-level disinfectant and chemical sterilant. It is noncorrosive
to metals, rubbers, and plastics and provides a means of sterilizing delicate lensed
instruments (e.g., endoscopes, cystoscopes, bronchoscopes).

MOA=Protein and nucleic acid alkylation

- Immersion time ( 2% glutaraldehyde) :
- 10 hours at 20°C–25°C [68°F–77°F] for sterilization
- 10 minutes at 20°C–25°C [68°F–77°F] for disinfection

- Ortho-phthalaldehyde (OPA) : superior mycobactericidal activity compared with glutaraldehyde

- Peracetic acid

PLASMA (Hydrogen Peroxide)

- H2O2 kills M.O by free radical generation

- Not suitable for linen, guaze swabs, paper
- Plasma sterilization uses ultraviolet (UV) photons and free radicals.
Advantage :
- Instruments can be sterilized at low temperatures (i.e., <50°C [122°F])
- short time intervals (i.e., 45 minutes),
- immediately available(Ready to use) because aeration is not required/Drying NOT
needed
- Safe for everyone
DETERMINATION OF SURGICAL RISK/Surgical Prognosis

Q. In poor surgical risk the chances of complication or death are [HPPSC VO-2021]
a) Less
b) More
c) Both
d) None

Q. ---------------------------is a poor surgical risk [Recent MCQ]

a) Amputation of gangrenous tail in 8 month pregnant cow
b) Rumenotomy in 8 month pregnant cow
c) D.H repair in 9.5 month pregnant cow
d) Surgical removal of an ulcerated mammary tumor in 8 year old dog
Preparation of the Operative Site

- Endogenous microbial flora ( Staphylococcus pseudintermedius) are the most common

source of surgical site infection (SSI) in dogs.

- Antisepsis is the prevention of sepsis by preventing or inhibiting the growth of resident

and transient microbes.

Characteristics of an Ideal Preoperative Antiseptic

- Kill all bacteria, fungi, viruses, protozoa, tubercle bacilli, and spores
- Be hypoallergenic
- Be nontoxic
- Have residual activity
- Not be absorbed
- Be nontoxic and be able to be used repeatedly safely
- Be safe to use on all parts of the body and in all body systems
Preparation of the Surgical Team

- Most surgical site infections (SSIs) are caused by the patient’s endogenous flora but
operating room (OR) personnel are also an important source of bacterial contamination.

Preparation of the Surgical Team

- Hair Coverings
- Footwear and Shoe Covers
- Masks
- Surgical Gowns
- Surgical Gloves
- SURGICAL SCRUB [ICAR VASIII-2019]
Q. Surgeon who is switching to other surgery right after finishing first surgery without breaking
the asepsis, should scrub hands for [ICAR VASIII-2019]
a) At least 2 min
b) At least 4 min
c) At least 6 min
d) At least 8 min

Over the past 3 decades, scrubs have gradually been reduced from 10 minutes to 2
minutes.

A 5- to 7-minute scrub for the first case of the day, followed by a 2- to 3-minute scrub
between subsequent operations, generally is adequate.
 Surgical Instrumentation

Scalpels
- Reusable scalpel handles (No. 3 and 4) with detachable blades are most commonly used
in veterinary medicine
- No. 10 blade is most commonly used in small animal surgery for incision and excision of
tissues.
- No. 11 blade is ideal for stab incisions into fluid-filled structures or organs
- No. 12 blade most often used in cats for elective dissection onychectomy (declawing)

Scissors [ICAR VASIII-2019]

- Metzenbaum (also called Metz, Nelson, delicate, or tissue scissors) or Mayo scissors are
most commonly used in small animal surgery

- Metzenbaum : for sharp and blunt dissection or incision of finer tissues

- Mayo scissors are used for cutting dense, heavy tissue, such as fascia

Q. The dissection of subcutaneous fascia during surgery should be done with

[ICAR VAS-III 2019]
a) Nelson scissors
b) Mayo scissors
c) Tissue scissors
d) Metzenbaum scissors

Hemostat Forceps

- Hemostat forceps are crushing instruments used to clamp blood vessels

- Mosquito hemostats = transverse jaw serrations, Smaller (7.6 cm [3 inch])
Tissue Forceps

- used to grasp or clamp tissue

- Allis tissue forceps : used to firmly grasp tissue that is going to be removed from the
body
- Babcock tissue forceps: more delicate than Allis, used on tissue remaining in the body
- Doyen intestinal forceps: noncrushing, occluding forceps, used to temporarily occlude
the lumen of the bowel

Surgical Needles

3 Parts of a needle : Point, Body, Swaged/Eye end

- Three-eighths(3/8) and one-half(1/2) circle needles are the most commonly used
surgical needles in veterinary medicine
- Straight (Keith) needles : placement of purse-string sutures in the anus
- One-fourth (1/4)circle needles : primarily used in ophthalmic procedures
 - Cutting needles : used for SKIN
- Side cutting needles (spatula needles) : used for ophthalmic procedures
- Taper needles (round needles) : used in easily penetrated tissues ( intestine,
subcutaneous tissue, or fascia)
- Tapercut needles: used for suturing dense, tough fibrous tissue( tendon) and for some
cardiovascular procedures, such as vascular grafts.
- Blunt point needles : occasionally used for suturing soft, parenchymal organs, such as
the liver or kidney.

Cleaning of instruments

- For instrument cleaning, use detergents with neutral or near-neutral pH (b/w 7 and 8)
- Low-pH detergents : corrode the protective surface of stainless steel if not fully rinsed
off,
- High-pH detergents: corrode or cause “browning” of instruments and may impair
function.
 SHOCK

SHOCK
STAGES OF SHOCK [ICAR VASIII-2020]

Q. Given below are two statements [ICAR VASIII-2020]

Statement I: Hypertension as a clinical sign indicates compensatory stage of shock
StatementII: Incresed capillary refill time as a clinical sign indicates compensatory stage of shock

In the light of the above statements, choose the most appropriate answer from the options
given below

a) Both Statement I and Statement II are true

b) Both Statement I and Statement II are false
c) Statement I is correct but Statement II is false
d) Statement I is incorrect but Statement II is true
PRACTICE SET WITH PREVIOUSLY ASKED ICAR MCQs
1. The following suture material is recommended in areas of suspected
contamination/infection
a) Chromic catgut
b) Silk
c) Polyglactin 910
d) Plain gut
2. Surgery done for correction of deformities/ malformations using ‘graft’ is called
a) Reconstructive
b) Plastic
c) Cosmetic
d) Exploratory
3. Which of the following is comparatively more dangerous wound
a) Contusion
b) Hematoma
c) Lacerated
d) Punctured
4. Radical surgery is a kind of surgery done to [ICAR VS-2019]
a) Conceive demage tissue
b) Eliminate root cause
c) Remove demage tissue
d) Correct malformation
5. What procedure is done to arrive at a diagnosis or for conformation of a disease
[LDO-2011,TNPSC AHVS-2019]
a) Reconstructive surgery
b) Experimental surgery
c) Clinical surgery
d) Exploratory surgery
6. Reconstructive surgery is surgery done for [ICAR VS-2020]
a) The correction of deformities
b) Preserving a disabled part
c) Removal of root cause of disease
d) The confirmation of a diagnosis
7. Surgery which is carried out to restore the normal function of body or a part without
substituting or replacing [HPPSC VO-2021]
a) Extirpative surgery
b) Plastic surgery
c) Restorative surgery
d) Replacement surgery
 8. Which is not an elective surgery [PPSC VO-2019]
a) Oesophagotomy in dog
b) Ovariohysterectomy in dog
c) Docking in 10 day old dog
d) Mastectomy in bitch
9. Surgery done to preserve or restore a disabled part is called[KPSC VS-2017]
a) Reconstructive surgery
b) Conservative surgery
c) Plastic surgery
d) None
10. Exploratory laprotomy is an example of [ICAR VAS-III 2019]
a) Clean surgery
b) Contaminated surgery
c) Clean contaminated surgery
d) Dirty surgery
11. The correct statement regarding the Tenets of Halstead (1852-1922) is
[GPSC VO-2016/17]
a) It is not applicable to key hole laparoscopic surgery
b) It is not relevant to the present day surgery
c) It is most relevant and applicable to the present day surgery
d) None of the above
12. Sudoriferous cyst involves [ICAR VS-2019]
a) Sweat gland
b) Sebaceous gland
c) Tarsal gland
d) Thyroid gland
13. What is a cyst resulting from failure of the branchial arches to fuse [TNPSC AHVS-2019]
a) Dentigerous cyst
b) Dermoid cyst
c) Urachal cyst
d) Honey cyst
14. Dentigerous cyst is seen in the horses in [OPSC VAS-2018]
a) Oral cavity
b) Pharynx
c) Temporal region
d) Mandibular region
 15. Misplaced embryonic cutaneous tissues is called [ICAR VASIII-2017]
a) Dentigerous cyst
b) Dermoid cyst
c) Retention cyst
d) Cyst
16. What is a tubular inflammatory tract opening at both ends connecting two surfaces
covered by epithelium [TNPSC AHVS-2019]
a) Bier’s hyperaemia
b) Fistula
c) Sinus
d) Carbuncle

17. During and after surgery, the bleeding from larger artery is mainly controlled by[LDO-
2012]
a) Transfixation ligation
b) Electrocoagulation
c) Digital compression
d) Application of styptics
18. The wounds of more than 6 to 8 hours duration are designated as [LDO-2012]
e) Contaminated wound
f) Infected wound
g) Maggoted wound
h) Surgical wound
19. The wound is known as infected if the bacterial count exceeds
[ICAR VASIII-2017,ICAR VS-2020]
5
e) 10 bacteria/gm
f) 106 bacteria/gm
g) 108 bacteria/gm
h) 107 bacteria/gm
20. Which phase of wound healing extends upto months or years [HPPSC VO-2017]
e) Hemostasis
f) Proliferative phase
g) Remodeling phase
h) None of these
21. In which stage of wound healing, centripetal movement of the whole thickness of the
surrounding skin appears[TNPSC AHVS-2019]
e) Inflammatory
f) Wound contraction
g) Wound maturation
h) Epithelialization
 22. Hydrogen peroxide (3%) liberates nascent oxygen by which one of the following present
at the surface of a wound or mucous membrane [ICAR VASIII -2020]
e) Catalase
f) Hyaluronidase
g) Peroxidase
h) Glucuronidase
23. Indicate which of the following is /are absorbable suture material/s [LDO-2019]
1. Linen
2. Terelene
3. Collagen
4. Vetafil
Answer options
a) Only 1 and 4
b) Only 2
c) Only 3
d) Only 4
24. A closed wound which is produced by blunt objects results in demage to subcutaneous
tissues without break in continuity of the skin surface is [TNPSC VAS-2020]
a) Bruise
b) Contusion
c) Haematoma
d) Seroma
25. Which of the following describes a wound healing achieved by secondary sutures
[TNPSC AHVS-2019]
a) First intention healing
b) Second intention healing
c) Mixed intention healing
d) Third intention healing
26. The type of wound healing in which granulation tissue forms, filling the defect, is known
as [PPSC VO-2019]
e) First intention
f) Second intention
g) Third intention
h) Fourth intention
27. Wound that is showing tendancy to heal is [ICAR VAS-III 2018]
e) Healing wound
f) Proud flesh
g) Granulating wound
h) Aseptic wound
28. Wound which does not heal is known as [MzPSC VO-2019]
e) Maggot wound
f) Ulcer
g) Infected wound
h) Contaminated wound
29. Last stage of wound healing is [MzPSC VO-2019]
e) Wound contraction
f) Epithelization
g) Fibroplasia
h) Vasodilatation
30. The enzyme used for debridement of a wound [PPSC VO-2019]
e) Bacterial collagenase
f) Bacterial protease
g) Bacterial lipase
h) Reverse transcriptase
31. A typical granulation tissue at the early stages of development exhibits following
features [OPSC VAS-2019/20]
e) Presence of giant cells
f) Presence of mature connective tissue
g) Marked angiogenesis and fibroblasts
h) Presence of collagen
32. Abnormal large amount of granulation tissue is known as [RPSC VO-2019]
e) Callus
f) Adenoma
g) Proud flesh
h) Sarcoma
33. An example of tendon suture is [ICAR VS-2020]
a) Parker-kerr
b) Bunnel
c) Far-Far-Near-Near
d) Far-Near-Near-Far
34. Non-absorbable suture used for internal organ is [ICAR VAS-III 2018]
a) Silk
b) Nylon
c) Catgut
d) Cargile membrane
35. Which of the following is not a non absorbable suture material [RPSC LSA-2016]
a) Silk worm gut
b) Catgut
c) Linen
d) Silk thread
36. Recurrence of rectal prolapsed is prevented by applying [ICAR VAS-III 2018]
a) Mattress suture
b) Overlapping suture
c) Purse string suture
d) Interrupted suture
37. The closed cavity filled with blood is known as [ICAR VS-2018]
e) Cyst
f) Haematoma
g) Abscess
h) sarcoma
38. Complete elimination of microorganism including both vegetative and spore form of
bacteria is called [HPPSC VO-2021]
a) Sterilization
b) Asepsis
c) Antiseptic disinfectant
39. The sterilization of the surgical instrument is carried out by [ICAR VS-2018]
a) Boiling water
b) Radiation
c) Autoclave
d) Chemicals
40. Autoclaving cannot be used for
a) Oily injections
b) Aqueous inject ions
c) Large volume paren terals
d) Plastic and rubber closures
41. For the ideal qualities of a sutures, which is not correct[LDO-2014]
i) Cause minimum tissue reaction
ii) More capillary in action
iii) Be knotable
iv) Have sufficient functional strength
a) ii b) iv c) iii d) i

42. Which of the following suture pattern comes under eversion suture pattern [TNPSC
AHVS-2019]
i) horizontal mattress
ii) lembert pattern
iii) cushing pattern
iv) vertical mattress
a) i only b) ii and iii c)I and iii d) i and iv

43. Catgut is prepared from the submucosal layer of the intestine(ileum) of [OPSC VAS-
2013]
a) Sheep
b) Rabbit
c) Cattle
d) Horse

44. Which suture material is absorbed most rapidly from an infected wound through
increased local phagocytic activity [ICAR VS-2018]
a) Vicryl (Polyglactin910)
b) PDS (Polydioxanone)
c) Catgut
d) Nylon
45. Suture pattern used to close a stump is [ICAR VS-2018]
a) Cushings
b) Lamberts
c) Parker kaer
d) Continuous lock stitch
46. Parker-kerr suturing pattern is associated with [MPPSC VAS-2018]
a) Small intestine anastomosis
b) Herniorrhaphy
c) Hernioplasty
d) None of these
47. Which suture pattern is considered in rumen suturing [PPSC VO-2019]
a) Cushing
b) Vertical mattress
c) Simple continuous
d) Cross mattress
48. A Buhner suture is applied for [RPSC VO-2019]
a) Ovariectomy in a bitch
b) Vaginal prolapse in a cow
c) Perineal laceration in a mare
d) Vulval hematoma in a sow
49. Bunnell suture technique is used for [RPSC VO-2019]
a) Muscle repair
b) Tendon repair
c) Ligament repair
d) Skin repair
50. Lock stich suture is used in [Mz PSC VO-2018]
a) Horned cancer
b) Laryngeal hemiplegia
c) Pollevil
d) Tracheostomy
 51. The most accepted way of suturing a uterus during caesarean operation is to start
suturing from [ICAR VASIII-2017]
a) Cervical end
b) Ovarian end
c) Can start from any end
d) To start from middle of the uterus
52. Overlapping mattress sutures are applied on [RPSC VO-2019]
a) Hernia ring
b) Hernia sac
c) Hernia contents
d) All of these
53. Suture size used for closure of skin in cow is[PPSC VO-2019]
a) No.2
b) No.3-0
c) No. 1-0
d) No.2-0
54. A double row of lambert suture is called [OPSC VAS-2018]
a) Cushing suture
b) Czerny suture
c) Connel suture
d) Reinforced suture
55. The following suture is used to narrow and constrict lumen of hollow organ [MPPSC
VAS-2018]
a) Eversion suture
b) Inversion suture
c) Purse-String suture
d) Apposition suture
56. Purse string sutures are applied in case of[MPPSC AHVS-2016]
a) Intestinal anastomosis
b) Rectal prolapse
c) Anal fistula
d) Anal acuilectomy
57. The most widely used absorbable suture material in veterinary
practice[GPSC V0-2016/17]
a) Linen
b) Plain catgut
c) Chromic catgut
d) Fish gut
58. What suture material is used to repair hernias or reinforce traumatized or devitalized
tissue[TNPSC AHVS-2019]
e) Staples
f) Autologous fibrin glue
g) Surgical mesh
h) Tissue adhesives
59. Which one of the following suture material belongs to organic non-absorbable
[TNPSC AHVS-2019]
a) Polyester
b) Silk
c) Nylon
d) Polypropylene
60. Extra chromic catgut gets absorbed in approximately [OPSC VAS-2018]
a) 10 days
b) 15 days
c) 20 days
d) 40 days
61. The following is an example of synthetic absorbable suture material [OPSC VAS-
2019/20]
a) Cotton
b) Cargile
c) Vicryl
d) Chromic catgut
62. Pervious urachus is [HPPSC VO-2017]
a) Prulent fistula
b) Congenital fistula
c) Incomplete fistula
d) Pathological fistula
63. The best treatment of fistula is [MzPSC VO-2019]
a) Antibiotics
b) Antibiotics and corticosteroids
c) Surgical removal
d) Counter irritants
64. Regarding surgical knots the correct statement is [GMC V0-2018]
e) Surgeon’s knot is more secure than square knot
f) Square knot is more secure than surgeon’s knot
g) Granny knot is more secure than square knot
h) Granny knot is more secure than surgeon’s knot
65. What is surgical knot recommended for suture material that are likely to slip[TNPSC
AHVS-2019]
e) Square knot
f) Granny knot
g) Nylon knot
h) Half hitch knot
 66. Vesicle formation is seen in this kind of burn injuries[OPSC VAS-2018]
a) First degree
b) Second degree
c) Third degree
d) Charring
67. Temponade plugging can be employed to control bleeding from[ICAR VASIII-2017]
a) Cavities
b) Surface wounds
c) Nostril
d) Mouth
68. Cauterization of vessels by mono-polar and bipolar coagulation is called [MzPSC VO-
2019]
a) Tourniquet
b) Ligation
c) Diathermy
d) All of these
69. Pervious urachus seen as a congenital condition is a [ICAR VASIII-2017]
a) Fistula
b) Sinus
c) Cyst
d) Hernia
70. Abscess should be open by Syme’s abscess knife at [MzPSC VO-2019]
a) Lateral part
b) Place of pointing
c) Medial part
d) All of these

71. Retention of cyst under the tongue in a buffalo is called[RPSC VO-2019]

a) Palatitis
b) Gnathitis
c) Gingivitis
d) Ranula
72. Ranula is a mucocele of[OPSC VAS-2013]
a) Parotid salivary gland
b) Mandibular salivary gland
c) Sublingual salivary gland
d) None of the above
73. The condition caused by rough roads and extra heavy loads in bullocks and buffalo bulls
[LDO-2011]
a) Haematoma
b) Cyst
c) Tumor
d) Yoke gall
74. The thread count muslin of cloth for sterilization wrap must be [ICAR VASIII-2017]
a) 100
b) 110
c) 130
d) 140
a)
75. Surgeon who is switching to other surgery right after finishing first surgery without
breaking the asepsis, should scrub hands for [ICAR VASIII-2019]
e) At least 2 min
f) At least 4 min
g) At least 6 min
h) At least 8 min
76. The dissection of subcutaneous fascia during surgery should be done with[ICAR VAS-III
2019]
a) Nelson scissors
b) Mayo scissors
c) Tissue scissors
d) Metzenbaum scissors
77. Cyst caused by distension of the tarsal gland with secretion is called [ICAR VASIII-2017]
a) Stye
b) Dacryoadenitis
c) Blepharitis
d) Chalazion
78. Diffuse spreading suppurative inflammation of connective tissue is known as [TNPSC
VAS-2020]
a) Phlegmon
b) Abscess
c) Pustule
d) Sinus
79. Given below are two statements [ICAR VASIII-2020]
Statement I: Hypertension as a clinical sign indicates compensatory stage of shock
StatementII: Incresed capillary refill time as a clinical sign indicates compensatory stage of shock

In the light of the above statements, choose the most appropriate answer from the options
given below

e) Both Statement I and Statement II are true

f) Both Statement I and Statement II are false
g) Statement I is correct but Statement II is false
h) Statement I is incorrect but Statement II is true

80. In which degree of burn injury the blisters are formed by exudation of plasma
[TNPSC AHVS-2019]
st
a) 1 degree
b) 2nd degree
c) 3rd degree
d) 4th degree

81. Given below are two statements [ICAR VASIII-2020]

Statement I: Lymphocytes are not essential for wound healing
Statement II: Fibroblasts are essential for wound healing

In the light of the above statements, choose the most appropriate answer from the options
given below
a) Both Statement I and Statement II are true
b) Both Statement I and Statement II are false
c) Statement I is correct but Statement II is false
d) Statement I is incorrect but Statement II is true
82. Each of the following may be present in acute inflammation EXCEPT [OPSC VAS-
2019/20]
a) Hyperemia
b) Eosinophils
c) Edema
d) Lymphocytes
83. Daily observation and evaluation are necessary after surgery, for a period of [ICAR VS-
2019]
a) 1—3 days
b) 5—7 days
c) 7—14 days
d) 3 weeks
84. Concentration of KMnO4 used for cleaning a wound is [ICAR VS-2019]
a) 10%
b) 5%
c) 3%
d) 1%
85. For gas sterilization, which of the following gas can be used[ICAR VS-2019]
a) Oxygen
 b) Nitrous oxide
c) Ethylene oxide
d) Carbon dioxide
86. Sterilization of operation theatre is done by [KPSC VS-2017]
a) Nitrous oxide gas
b) Steaming
c) Ethylene oxide gas
d) UV irradiation

87. Bacteria Bacillus stearothermophilus is used as biological indicator for[ICAR VASIII-2017]

a) Gas sterilization
b) Steam sterilization
c) Cold sterilization
d) Chemical sterilization
88. Cellulitis means inflammation of [TNPSC AHVS-2019]
a) Epidermal cells of skin
b) Dermis alone
c) Dermis and subcutis
d) Intracellular infiltration
89. Yoke gall is a/an [MPPSC AHVS-2016]
a) Cyst
b) Tumour
c) Abscess
d) Oedematous swelling
90. In poor surgical risk the chances of complication or death are [HPPSC VO-2021]
a) Less
b) More
c) Both
d) None

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