Third Edition
Pritesh Kumar
Singh
MBBS (MAMC) MS (Surgery) FMAS FIAGES
Director PGEI
Ex. Senior Resident, Lady Hardinge Medical College and Associated Sucheta Kriplani, Kalawati Saran and RML Hospital,
New Delhi
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Surgery Essence
Second Edition: 2014
Third Edition: 2015
9789351528883
Printed at
fm3Dedicated to
My Parents and Uncle, Dr CP Singh
fm5Editors
ENDOCRINE SURGERY
- Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
- Dr Subham Jain (MCh, Surgical Oncology, TATA)
- Dr Subham Garg (MCh, Surgical Oncology, TATA)
HEPATOBILIARY PANCREATIC SURGERY
- Dr Swati Agarwal (DNB, Surgical Oncology)
- Dr Vaibhav Varshney (MCh, GI Surgery, GB Pant Hospital)
- Dr Harsh Shah (MCh, GI Surgery, GB Pant Hospital)
- Dr Amit Jain (MCh, GI Surgery, GB Pant Hospital)
GASTROINTESTINAL SURGERY
- Dr Vaibhav Varshney (MCh, GI Surgery, GB Pant Hospital)
- Dr Swati Agarwal (DNB, Surgical Oncology)
- Dr Harsh Shah (MCh, GI Surgery, GB Pant Hospital)
- Dr Amit Jain (MCh, GI Surgery, GB Pant Hospital)
UROLOGY
- Dr Gaurav Kochar (MCh, Urology)
- Dr Suhani (Assistant Professor, Surgery, AIIMS)
- Dr Manoj Kumar Das (MCh, Urology)
- Dr Animesh Singh (MCh, Urology, AIIMS)
CARDIOTHORACIC VASCULAR SURGERY
- Dr Tarun Raina (MCh, CTVS, GB Pant Hospital)
- Dr Vivek Wadhva (MCh, CTVS, PGI Chandigarh)
PLASTIC SURGERY
- Dr Ritesh Anand (MCh, Plastic Surgery)
- Dr Alok Tiwari (MCh, Plastic Surgery)
NEUROSURGERY
- Dr Amit Kumar Singh (MCh, Neurosurgery, RML Hospital)
- Dr Shivender Sobti (MCh, Neurosurgery, RML Hospital)
- Dr Ishu Bishnoi (MCh, Neurosurgery, GB Pant Hospital)
- Dr Ugan Singh (MCh, Neurosurgery)
HEAD AND NECK
- Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
- Dr Subham Jain (MCh, Surgical Oncology, TATA)
- Dr Subham Garg (MCh, Surgical Oncology, TATA)
SURGICAL ONCOLOGY
- Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
- Dr Subham Jain (MCh, Surgical Oncology, TATA)
- Dr Subham Garg (MCh, Surgical Oncology, TATA)
GENERAL SURGERY
- Dr Niket Harsh (MS, Surgery)
- Dr Mohit Garg (MS, Surgery)
I thought writing the preface for the third time would be an easier job but it is actually a lot tougher because now you already know me very well. This brings many responsibilities with it, the most important of which is to keep the students satisfied.
I can proudly say that all my students have contributed a lot to get me to this place, where I am today. They have helped me in becoming a better teacher, a better author and most importantly a better human being. I take this opportunity to thank all of you. The happiness you all give me keeps me telling always to work harder to bring a positive change in the life of my students. This will be reflected in the pages of this book. I always strive to provide a winning edge to my students.
Higher education has become necessary, as graduation alone is found inadequate in this highly competitive and dynamic world. Trends in the way the questions are being asked are changing continuously. I am pleased to present this edition of Surgery Essence replete with new trends in the field of surgery. The recent questions and their concepts have been highlighted and have been written in a way that will help the students to remember and reproduce them in the examination hall. The information provided is cogent but concise to save the precious time, as we all know the clock is ticking. Time is one thing that can never be recovered once gone. Be careful!
I am passionate about excellence. Excellence in the field of education and in my efforts to groom my students to make them confident enough, that they lose the fear of failure. In order to succeed, your desire for success should be greater than your fear of failure.
PG entrance examination has made the medical world very competitive and has made it imperative for students to acquire all the skills and competencies to deliver results. My aim as an author is to provide students with a learning experience which when amalgamated with perseverance and commitment helps them in achieving goals.
I still am not sure about one thing that who is more happy when a student achieves something, the student or the teacher, but I am very sure that the teacher is more satisfied when he sees his students achieving what they deserve and desire. I am working day and night to get that satisfaction and you have to work equally hard so that you do not let me down.
I always tell my students to dream big but not while sleeping. When you dream of moon, you will at least fall amongst stars. But these dreams should always be accompanied with intelligence and hard work. To guide you work intelligently this book and the author, both are there with you throughout the year. But the hard work is totally in your hands. Accept responsibility for your life. Know it is you who will get you where you want to go, no one else.
I believe that all my students should know the importance of challenges. Challenges are what make life interesting and overcoming them is what makes life meaningful. For the time being the only challenge that you should be facing is to secure a good rank in the entrance exam. One of the most important keys to success is having the discipline to do what you know you should do, even when you do not feel like doing it. Nobody ever wrote down a plan to be broke, lazy or stupid. These things happen when you do not have a plan.
I should now conclude with my prayers and wishes for all of you. Hope you all reach your dreams. All the best...
PRITESH KUMAR SINGH
/drpriteshsingh | /drpriteshsingh | ||
Today is the world of specialization and for students of medical profession, obtaining specialization in one field is of utmost significance. From my experience till now, I have come to a conclusion that there is a dearth of good books on postgraduation entrance exam in surgery. Thus, in the form of this book I have made an attempt to make a meaningful contribution for the same. I had started working on this project soon after I joined my postgraduation course and after four years of regular hard work which includes the period of preparation for my super specialization, I could bring this book. The writing of this book has also helped me in understanding the subject in a better way and I feel that I have grown better as a surgeon while writing this book.
The pattern of questions in postgraduation entrance examination has changed after introduction of NEET but when one is thorough with the subject it is a lot easier to secure a good rank in the exam. For that matter, I have incorporated explanations with every question to broaden the scope of the question. The explanations have been written in a cogent manner and without any ambiguity. The sources have been mentioned in the references so that in case of a doubt one can always go back to the textbooks. The explanations have been taken from standard textbooks available for super specialty and recent journal review articles so that one can get the best preparation without wastage of precious time of going through all those books. This has also helped me to prepare better for the controversial questions which always bring anxiety in the minds of the students.
For the best results, along with hard work, one has to strike a proper balance between the way of attempting questions, which should be strategy and time management. Time management is required not just during the examination but also during the preparation of that exam. That is why they say that one who fails to plan is planning to fail. I have tried my best to provide thorough information about a particular topic which is required for the exams coupled with effective utilization of the available time.
Most of us are generally busy in marking the facts which are important in the books without realizing that the effort would go in drain if we do not get the time to revise the same. So the practice of taking only a single reading from any book should be avoided as the net output required to be produced during the exams is not fulfilled. In this book, such key points and facts have already been highlighted; tables and line diagrams have been provided to help you revise the subject quickly before the exams.
Although every effort has been made to minimize the scope of error but still some mistakes might be there which should be brought to the notice of the author through e-mail address or in writing.
I would like to express my immense gratitude to all my colleagues, friends, teachers and family because this book is the result of encouragement, appreciation and guidance from all of them.
Wishing you all the best and looking forward for your feedback and suggestions…
PRITESH KUMAR SINGH
fm11Acknowledgments
I would like to express my greatest gratitude to the people who have helped and supported me throughout my project.
I wish to thank my parents for their undivided support and interest, who inspired me and encouraged me to go my own way, without whom I would be unable to complete my project.
I want to thank active members of PGEI family for their encouragement, support and feedback especially Mr Ganesh, Mrs Janaki, Dr Suyog Sahu, Mr Niraj Salunke, Dr Rituparna Majumdar, Dr Debdatta Majumdar, Mr Raja Rao and Dr Sushanta Bhanja.
I feel pleasure in conveying my sincere thanks to my fiancée Dr Ushika Singh (MD, Anesthesia) for helping me throughout this project and giving her valuable advices and feedbacks.
I express my sincere thanks to my friends Dr Niket Harsh (MS, Surgery, MAMC) and Dr Saurabh Rai (MS, Orthopedics). They provided me the explanations of difficult and controversial questions.
I am grateful to Dr MP Arora for the continuous support for the project, from initial advice and contacts in the early stages of conceptual inception and through ongoing advice and encouragement to this day.
I sincerely thank my uncle Dr SD Maurya (President SELSI and Ex. Professor of Surgery, SNMC, Agra) for his valuable advice and knowledge regarding the surgery subject and surgical skills, which helped me a lot in preparation of certain topics of surgery given in this book.
I wish to express my sincere thanks to Dr OP Pathania and Dr S Thomas.
I wish to express my sincere thanks to Dr Manoj Andley, Professor of surgery, LHMC, New Delhi for helping me throughout this project. His caring and fatherly attitude for the unit as well as towards his residents needs a mention. His excellent way of teaching and presentation helped me a lot in making various explanations in the book. His hard working and caring attitude towards patients is source of inspiration for me and surgery residents.
I am very thankful to Dr Ashok Kumar, Professor of surgery, LHMC, New Delhi for his valuable and indispensable help. His unique ideas regarding presentation of explanations helped me a lot in this project. It is with the help of his valuable suggestions, guidance and encouragement, that I was able to complete this project.
I am very thankful to Dr SK Tudu, Professor of Surgery, Lady Hardinge Medical College for the valuable help. He was always there to show us the right track when we needed his help. It is with the help of his valuable suggestions, guidance and encouragement, that I was able to complete this project.
I wish to express my sincere thanks to Dr Lalit Aggarwal, Dr Gyan Saurabh, Dr Sudipta Saha, Dr P Rahul, Assistant Professor of Surgery, Lady Hardinge Medical College for guiding me to complete general surgery topics.
I wish to express my sincere thanks to Dr Pawan Kumar, Dr Priya Hazrah, Dr Nikhil Talwar, Dr Ezaz Siddiqui, Dr Ashish Arsia, Dr Sadan Ali, Dr Jitender and Dr Kusum Meena, Assistant Professors of Surgery, Lady Hardinge Medical College for their indispensable contribution.
I would like to thank Dr UC Garga, Professor of Radiology, Dr RML Hospital, New Delhi, for his special guidance for radiology and valuable advices for improvement of the book and boosting my morale to bring this project.
I express my extreme gratitude for immense inspiration from my family members specially:
- Dr Avinash Kumar Singh (Urologist)
- Dr Charu Singh (Dermatologist)
- Mr Abhay Kumar Singh (MBA, IMT, Ghaziabad)
- Mrs Deepasha Singh (MBA, IMT, Ghaziabad)
- Mr Ritesh Kumar Singh (B Tech, MBA, Symbiosis, Pune)
- Ms Pratibha Singh (M Tech, Computer Science)
- Ms Monika Singh (B Tech, Computer Science)
- Ms Khushboo Singh (B Tech, Computer Science)
- Mr Rohit Kumar Singh (B Tech, Computer Science)
- Dr Anita Singh (MD Pediatrics, KGMC, Lucknow)
- Dr Kundan Kumar Patel (MBBS, GSVM, Kanpur)
- Dr Akanksha Singh (DGO, KGMC)
- Dr Jigyasa Singh (MS, Gynae IMS, BHU)
- Mr Abhishek Kumar Singh (B Tech, IIT Kharagpur)
- Dr Ambuj Kumar Singh (MBBS, Era Medical College, Lucknow)
I would like to specially thank my friends for their invaluable help and advice from time to time specially:
- Dr Niket Harsh
- Dr Suarabh Rai
- Dr Kumar Saurabh
- Dr Gyan Ranjan Nayak (MS, ENT)
I feel pleasure in conveying my sincere thanks to my friends and colleagues specially:
- Dr Kirti Patel (MS, Gynae)
- Dr Nakshi Sinha (MD, Biochemistry)
- Dr Mayank Agarwal (MS, Surgery)
- Dr Shweta Mittal (MS, ENT)
A special thank of mine goes to Dr Parul Gautam, (MD, Pathology, MAMC), who helped me in completing the project and exchanged her interesting ideas, thoughts which made this project easy and accurate. Her help for topics related to tumor and pathology is indispensable.
I am equally grateful to my friend Dr Sushant Bhanja (MD, Pediatrics), who gave me moral support and guided me in different matters regarding the topics related to Pediatric surgery. He has been very kind and patient, whilst suggesting me the outlines of this project and correcting my doubts.
I would be failing in my duty if I do not express my thanks to all my friends who have really inspired me to write this book specially:
- Dr Vivek Kumar (MD, Medicine)
- Dr Neha Chaudhary (MD, Pediatrics)
- Dr Harwinder (MS, Orthopedics)
- Dr Nitasha (MS, Ophthalmology)
- Dr Ugan Singh (Mch, Neurosurgery)
- Dr Pragati Meena (MS, Gynae, SMS, Jaipur)
- Dr Bhamini Agal (MS, Gynae, SMS, Jaipur)
- Dr Aniket Malhotra (MD, Pediatrics)
- Dr Anant Pachisia (MD, Anesthesia)
- Dr Anant Shukla (MD, Anesthesia)
I would like to express my sincere thanks to my colleagues at Dr RML Hospital, especially Dr Amit Kumar Singh (MCh, Neurosurgery), Dr Shivender Sobti (MCh, Neurosurgery), Dr Humam (SR, Neurosurgery), Dr Wazid (DNB, Neurosurgery), Dr Uzair (DNB, Neurosurgery), Dr Azaz (DNB, Neurosurgery) and Dr Neeraj (DNB, Neurosurgery).
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, Dr Sushma Kataria, Dr Gyan Ranjan, Dr Kamal Yadav, Dr Priyank Yadav, Dr Vineet, Dr Munish, Dr Nivedita, Dr Tarun Raina, Dr Sumit Saini and Dr Abhinav Veerwal.
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, Dr Meenakshi, Dr Ankur, Dr Prashant, Dr Rigved, Dr Munish Raj, Dr Diwakar Pandey, Dr Vikram Deswal, Dr Gunjan Desai, Dr Vikas, Dr Nikunj Jain, Dr Hari Singh, Dr Vimlesh, Dr Mannu, Dr Anshul, Dr Vikas and Dr Abhijeet Jha, Dr Mayank Aggarwal, Dr Vipul Dogra, Dr Abhishek, Dr Kunjan, Dr Sumit, Dr Kartikey, Dr Rao Bhupender.
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, for their valuable advice, specially:
- Dr Ravindra Gupta (Ex. SR, RML Hospital)
- Dr Prasad Bhukebag (SR, RML Hospital)
- Dr Ritesh Pathak (SR, RML Hospital)
- Dr Anil Gulwani (Mch, Urology)
- Dr Nitin Sardana (Ex-SR, LHMC)
- Dr Arvinda PS (SR, LHMC)
- Dr Rahul Rai (Ex-SR, LHMC)
- Dr Yogender (SR, LHMC)
- Dr Anand Yadav (Ex-SR, LHMC)
- Dr Shiv Navariya (SR, LHMC)
- Dr Nihar (Mch-Hepatobiliary surgery SR, LHMC)
- Dr Zuber Khan (FNB, Minimal Invasive Surgery, LHMC)
I would like to express my sincere thanks to my colleagues at Maulana Azad Medical College and Associated LNJP Hospital for their valuable advice, specially:
- Dr Mohit Garg (MS, Surgery)
- Dr Kamal Kishore Gautam (MS, Surgery)
- Dr Anurag Mishra (MS, Surgery)
- Dr Ashish Airen (MS, Surgery)
I would also like to thank my assistant, Rajesh Jha, who often helped me at critical junctures during the completion of this project.
I would also like to thank Mr Varish Sharma and Mr Anurag Sharma of MAMC Bookshop for their encouragement for writing this book.
I would like to thank Dr Ashish Jakhetiya and Dr Inderjeet Yadav, who helped me a lot in gathering different information, collecting data and guiding me from time to time in completing this project. Despite their busy schedules, they gave me different ideas to help make this project unique.
I convey my sincere thanks to Dr Yatin Talwar for his constant encouragement and feedback regarding improvement of quality of explanations.
I convey my sincere thanks to my PGEI Delhi staff members Mr Isac Thaoveinii (Manager), Mr Mohit Singh (Assistant Manager), and Mr Rajesh Jha (Class Coordinator).
Last but not the least I want to thank all my students who appreciated me for my work and motivated me and finally to God who made all the things possible.
I feel pleasure in conveying my sincere thanks to Ms Chetna Malhotra Vohra (Associate Director), Ms Saima Rashid (Project Manager) for helping me throughout this project and giving their valuable advices and feedback.
I convey my sincere thanks to the team of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for their efforts and suggestions in timely publication of the book.
fm15Annexures
Annexure 1
NAMED CLASSIFICATION FOR TUMORS
Important Tumor Classification | |
---|---|
Chang stagingQ | MedulloblastomaQ |
Masoaka stagingQ | ThymomaQ |
Shimda indexQ | NeuroblastomaQ |
Reiss and Ellsworth classification Esson prognostic indexQ | RetinoblastomaQ |
Bloom-Richardson gradingQ | CA breastQ |
Naguchi classificationQ | Adenocarcinoma lungQ |
Sullivan modification of Macfalene systemQ | Adrenocortical carcinomaQ |
Gleason | CA prostateQ |
Nevine staging | CA GBQ |
Duke staging | Colorectal carcinomaQ |
Robson staging | RCCQ |
Jackson | CA penisQ |
Annexure 2
GENES AND CHROMOSOMES
Syndrome | Genes | Locations |
---|---|---|
Breast/ovarian syndrome | BRCA1 | 17 |
BRCA2Q | 13Q | |
Cowden's disease | PTENQ | 10Q |
FAP | APCQ | 5Q |
HNPCC | hMLH1Q | 3Q |
hMSH2Q | 2Q | |
hMSH6 | 2Q | |
hPMS1 | 2Q | |
hPMS2 | 7Q | |
Hereditary papillary RCC | METQ | |
Li-Fraumeni | p53Q | 17Q |
hCHK2 | 22 | |
MEN-1 | MEN1Q | 11Q |
MEN-2 | RETQ | 10Q |
NF-1 | NF1Q | 17Q |
NF-2 | NF2Q | 22Q |
Peutz-Jeghers syndrome | STK11Q | 19Q |
Retinoblastoma | RBQ | 13Q |
Tuberous sclerosis | TSC1Q | 9Q |
TSC2Q | 16Q | |
VHL syndrome | VHLQ | 3Q |
Wilms’ tumor | WTQ | 11Q |
NAMED TRIADS
Important Triads | ||
---|---|---|
Triad | Seen in | Components |
Virchow's TriadQ | Thrombosis | Hypercoagulability + Stasis + Endothelial injuryQ |
Galezia's TriadQ | Dupuytren's contracture + Retroperitoneal fibrosis + Peyronie's disease of penisQ | |
Cushing's TriadQ | Intracranial hypertension | BP + Bradycardia + respiratory rate |
Hutchison's TriadQ | Congenital syphilis | Hutchison's teeth (notched upper incisors) + Interstitial keratitis + Nerve deafnessQ |
Trotter's TriadQ | Nasopharyngeal Carcinoma | Conductive hearing loss + Immobility of homolateral soft palate + Trigeminal neuralgiaQ |
Important Triads | ||
---|---|---|
Triad | Seen in | Components |
Saints Triad | Hiatus hernia + Gallstones+ Colonic diverticulosisQ | |
Dieulafoy's TriadQ | Acute appendicitis | Hypersensitiveness of skin + Reflex muscular contraction + tenderness at Mac Burney's pointQ |
Quinck's TriadQ | Hemobilia | GI hemorrhage + biliary colic + jaundiceQ |
Borchardt's TriadQ | Gastric Volvulus | Epigastric pain + Inability to vomit + Inability to pass a NG tubeQ |
Tillaux's TriadQ | Mesenteric cyst | Soft fluctuant swelling in umbilical region + Freely mobile perpendicular to mesentery + Zone of resonance all aroundQ |
Mackler's TriadQ | Boerhaave's syndrome | Thoracic pain + vomiting + cervical subcutaneous emphysemaQ |
Rigler's TriadQ | Gall stone ileus | Small bowel obstruction + Pneumobilia + Ectopic gallstoneQ |
Whipple's TriadQ | Insulinoma | Symptoms of hypoglycemia + S. glucose <45 mg/dl + Symptomatic relief on glucose ingestionQ |
Annexure 4
LYMPH NODES
Most Common Lymph Nodes Involved | |
---|---|
CA Penis | Inguinal LNQ |
CA Testis | On right: Inter-aortocavalQ LN On left: ParaaorticQ LN |
CA Bladder | ObturatorQ LN |
CA Prostate | ObturatorQ LN |
Important Lymph Nodes | |
---|---|
Rotter's nodesQ |
|
Rouvier nodesQ |
|
Delphian nodesQ |
|
Irish nodesQ |
|
Sister Mary Joseph nodesQ |
|
Virchow nodesQ |
|
Cloquet nodeQ |
|
LN of LundQ |
|
Krouse Lymph node |
|
METASTASIS
Carcinoma Thyroid | |
---|---|
Type | Mode of spread |
Papillary carcinoma | LymphaticQ spread |
Follicular carcinoma | HematogenousQ spread |
Medullary carcinoma | Both lymphatic and hematogenousQ spread |
Anaplastic carcinoma | Direct invasionQ |
Carcinoma Thyroid | |
---|---|
Type | MC site of Metastasis |
Papillary carcinoma | LungsQ |
Follicular carcinoma | BonesQ |
Medullary carcinoma | LiverQ |
Anaplastic carcinoma | LungsQ |
Pulsating Secondaries |
---|
|
Bone Metastasis in Carcinoma Thyroid | |
---|---|
Follicular carcinoma | Osteolytic metastasis (Pulsating secondaries in flat bones) Q |
Medullary carcinoma | Osteoblastic metastasisQ |
Metastatic Tumors |
---|
Metastatic Tumors of Thyroid
|
Metastatic Tumors to lung, MC primary: CA breastQ |
Metastatic Tumors to Pancreas
|
Metastatic Tumors Adrenal, MC site of primary: CA LungQ |
Metastatic Tumors to Small Bowel
|
Metastatic Tumors |
Metastatic Tumors to Skin
|
Metastatic Tumors to Liver
|
Metastatic Tumors to CNS
|
Metastatic Tumors to esophagus, MC primary: CA lungQ |
Metastatic Tumors to spleen
|
Metastatic Tumors to Heart
|
Metastatic Tumors to Testis
|
Metastatic Tumors to penis, MC site of primary: CA bladderQ |
Annexure 6
MOST COMMON SYMPTOMS AND CHEMOTHERAPY
GI Malignancy | Chemotherapy |
---|---|
| ECF (E pirubicin + C isplatin + 5- F U)Q |
| ECF (E pirubicin + C isplatin + 5- F U)Q |
| GemcitabineQ |
| Streptozocin + 5-FUQ |
| Gemcitabine + CisplatinQ |
| Gemcitabine + CisplatinQ |
| 5-FUQ |
| FOLFOX-IV (5-FU + Leucovorin + Oxaliplatin)Q |
| Nigro Regimen: Chemoradiation (5-FU + Mitomycin C + Radiation)Q |
Most Common Symptom | |
---|---|
CA Esophagus |
|
CA stomach |
|
Periampullary carcinoma ( including CA head of pancreas) |
|
HCC |
|
Cholangiocarcinoma |
|
CA Gallbladder |
|
CA small bowel |
|
CA colon |
|
CA rectum |
|
CA anal canal |
|
MOST COMMON SITES
Important Most Common Sites | |
---|---|
| Lesser curvature (near incisura angularis) |
| 1st part of duodenum |
| Duodenum |
| Jejunum |
| Terminal Ileum |
| Cecum and ascending colon |
| Splenic flexure |
| Sigmoid |
| Rectum |
Annexure 8
TREATMENT OF CHOICE
Condition | Treatment of Choice |
---|---|
Duodenal Atresia | DuodenoduodenostomtyQ |
Annular pancreas | DuodenoduodenostomtyQ |
Superior mesenteric artery syndrome | DuodenojejunostomyQ |
Enucleation is treatment of choice in |
---|
|
CHARACTERISTIC RADIOLOGICAL APPEARANCES
Radiological Features | Seen in |
---|---|
| Carcinoma colonQ |
| IntussusceptionQ |
| Colonic diverticula |
| AchalasiaQ Volvulus |
| Diffuse esophageal spasmQ |
| Crohn's diseaseQ Tuberculosis |
| Ischemic colitisQ |
| Colonic lipomaQ |
| AchalasiaQ |
Characteristic Appearances | |
---|---|
ADPKD |
|
Infantile PKD |
|
Medullary Sponge Kidney |
|
Multicystic Dysplastic Kidney |
|
Renal Artery Aneurysm |
|
Ectopic Ureteric Orifice |
|
Retrocaval Ureter |
|
Retroperitoneal Fibrosis |
|
CA Renal Pelvis |
|
Radiological feature | Disease |
---|---|
| Hydronephrosis |
| Polycystic Kidney |
| Horse shoe Kidney |
| TB bladder |
| Ectopic ureter |
| Ureterocele |
| Analgesic nephropathy causing papillary necrosis |
| Tubercular chronic cystitis |
| Schistosomiasis of bladder |
| |
| BPH |
| Polycystic kidney |
Radiological Appearance | ||
---|---|---|
Acute Pancreatitis | Chronic Pancreatitis | CA Pancreas |
|
|
|
Annexure 10
ABDOMINAL EXAMINATION SIGNS
Abdominal Examination Signs | ||
---|---|---|
Sign | Description | Diagnosis |
Aaron sign | Pain or pressure in epigastrium or anterior chest with persistent firm pressure applied to McBurney's pointQ | Acute appendicitisQ |
Bassler sign | Sharp pain created by compressing appendix between abdominal wall and iliacus | Chronic appendicitis |
Blumberg's sign | Transient abdominal wall rebound tendernessQ | Peritoneal inflammation |
Carnett's sign | Loss of abdominal tenderness when abdominal wall muscles are contracted | Intra-abdominal source of abdominal pain |
Chandelier sign | Extreme lower abdominal and pelvic pain with movement of cervix | Pelvic inflammatory disease |
Claybrook sign | Accentuation of breath and cardiac sounds through abdominal wall | Ruptured abdominal viscus |
Courvoisier's sign | Palpable gallbladder in presence of painless jaundiceQ | Periampullary tumorQ |
Cruveilhier sign | Varicose veins at umbilicus (caput medusae)Q | Portal hypertensionQ |
Danforth sign | Shoulder pain on inspiration | Hemoperitoneum |
Fothergill's sign | Abdominal wall mass that does not cross midline and remains palpable when rectus contracted | Rectus muscle hematomas |
Mannkopf's sign | Increased pulse when painful abdomen palpated | Absent if malingering |
Ransohoff sign | Yellow discoloration of umbilical region | Ruptured CBDQ |
Ten Horn sign | Pain caused by gentle traction of right testicleQ | Acute appendicitisQ |
FAMILIAL CANCER SYNDROMES
Familial Cancer Syndromes | |||
---|---|---|---|
Syndrome | Genes | Locations | Cancer Sites and Associated Traits |
Breast/ovarian syndrome | BRCA1 | 17 q21Q | Cancer of breast, ovary, colon, prostateQ |
BRCA2 | 13 q12.3Q | Cancer of breast, ovary, colon, prostate, gallbladder and biliary tree, pancreas, stomach; melanomaQ | |
Cowden's disease | PTEN | 10 q23.3Q | Cancer of breast, endometrium, thyroidQ |
FAP | APC | 5q21Q | Cancer of breast, endometrium, thyroid |
Familial melanoma | p16 | 9p21 | Melanoma, pancreatic cancer, dysplastic nevi, atypical moles |
CDK4 | 12q14 | ||
Hereditary diffuse gastric cancer | CDH1 | 16q22 | Gastric cancer |
HNPCC | hMLH1Q | 3 p21Q | Colorectal cancer, endometrial cancer, transitional cell carcinoma of ureter and renal pelvis, carcinomas of the stomach, small bowel, pancreas, ovaryQ |
hMSH2Q | 2 p22-21 | ||
hMSH6 | 2 p16Q | ||
hPMS1 | 2 q31.1 | ||
hPMS2 | 7 p22.2Q | ||
Hereditary papillary RCC | METQ | 7 q31Q | Renal cell cancer |
Hereditary paraganglioma and pheochromocytoma | SDHB | 1p36.1-p35 | Paraganglioma, pheochromocytoma |
SDHC | 1q21 | ||
SDHD | 11q23 | ||
Juvenile polyposis coli | BMPRIA | 10q21-q22 | Juvenile polyps of the gastrointestinal tract, gastrointestinal malignancies |
SMAD4/DPC4 | 18q21.1 | ||
Li-Fraumeni | p53 | 17 p13Q | Breast cancer, soft tissue sarcoma, osteosarcoma, brain tumors, adrenocortical carcinoma, Wilms’ tumor, phyllodes tumor (breast), pancreatic cancer, leukemia, neuroblastomaQ |
hCHK2 | 22q12.1 | ||
MEN-1 | MENINQ | 11 q13Q | Pancreatic islet cell tumors, parathyroid hyperplasia, pituitary adenomasQ |
MEN-2 | RETQ | 10 q11.2 | Medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasiaQ |
MYH-associated adenomatous polyposis | MYH | 1p34.3-p32.1 | Cancer of the colon, rectum, breast, stomach |
Neurofibromatosis-1 | NF1Q | 17 q11Q | Neurofibromas, neurofibrosarcoma, acute myelogenous leukemia, brain tumorsQ |
Neurofibromatosis -2 | NF2Q | 22 q12Q | Acoustic neuromas, meningiomas, gliomas, ependymomasQ |
Nevoid basal cell carcinoma | PTC | 9q22.3 | Basal cell carcinoma |
Peutz-Jeghers syndrome | STK11Q | 19 p13.3Q | Gastrointestinal carcinomas, breast cancer, testicular cancer, pancreatic cancer, benign pigmentation of skin and mucosaQ |
Retinoblastoma | RBQ | 13 q14Q | Retinoblastoma, sarcomas, melanoma, malignant neoplasms of the brain and meningesQ |
Tuberous sclerosis | TSC1 | 9 q34 | Multiple hamartomas, RCC, astrocytoma |
TSC2 | 16 p13 | ||
von Hippel-Lindau syndrome | VHLQ | 3 p25Q | RCC, hemangioblastomas of retina and CNS, pheochromocytomaQ |
Wilms’ tumor | WTQ | 11 p13Q | Wilm's tumor, aniridia, genitourinary abnormalities, mental retardationQ |
SUTURES
Suture | Types | Raw material | Tensile strength | Absorption rate |
---|---|---|---|---|
Silk | Braided or twisted multifilament; Coated (with wax or silicone) or uncoated | Natural protein Raw silk from silkworm | Loses 20% when wet; 80–100% lost by 6 months | Fibrous encapsulation in body at 2–3 weeks; Absorbed slowly over 1–2 yearQ |
Catgut | Plain | Collagen derived from healthy sheep or catle | Lost within 7–10 days | Phagocytosis and enzymatic degradation within 7–10 daysQ |
Catgut | Chromic | Tanned with chromium salts to improve handling and resist degradation in tissueQ | Lost within 21–28 days | Phagocytosis and enzymatic degradation within 90 days |
Polyglactin (Vicryl) | Braided multifilament | Copolymer of lactide and glycolideQ in a ratio of 90:10, coated with polyglactin and calcium stearate | Approx, 60% remains at 2 weeks; 30% remains at 3 weeks | Hydrolysis minimal until 5-6 weeks; Complete absorption 60-90 daysQ |
Polyglyconate | Monofilament Dyed or undyed | Copolymer of glycolic acid and trimethylene carbonateQ | Approx, 70% remains at 2 weeks; 55% remains at 3 weeks | Hydrolysis minimal until 8-9 weeks; Complete absorption 180 daysQ |
Polyglycaprone | Monofilament | Coplymer of glycolite and caprolactoneQ | 21 days maximum | 90–120 daysQ |
Polyglycolic acid (Dexon) | Braided multifilament Dyed or undyed Coated or Uncoated | Polymer of polyglycolic acidQ | Approx, 40% remains at 1 weeks; 20% remains at 3 weeks | HydrolysisQ minimal at 2 weeks; significant at 4 weeks; Complete absorption 60–90 daysQ |
Polydioxanone (PDS) | Monofilament dyed or undyed | Polyester polymerQ | Approx, 70% remains at 2 weeks; 50% remains at 4 weeks; 14% remains at 8 weeks | Hydrolysis minimal at 90 days; Complete absorption 180 daysQ |
Guidelines for Day of Suture Removal by Area | |||
---|---|---|---|
Body Regions | Removal | Body Regions | Removal |
Eyelid | 3–4 | Chest, abdomen | 8–10 |
Eyebrow | 3–5 | Ear | 10–14 |
Nose | 3–5 | Back | 12–14 |
Lip | 3–4Q | Extremities | 12–14 |
Face (other) | 3–4Q | Hand | 10–14 |
Scalp | 6–8Q | Foot, sole | 12–14 |
NEW DRUGS IN SURGERY
New Drugs in CA Breast | |
---|---|
Ixabepilone |
|
Lapatinib |
|
Sunitinib |
|
New Drugs | |
---|---|
Drug | Indication |
Imatinib mesylate |
|
Sunitinib |
|
Sorafenib |
|
Geftinib |
|
Lapatinib |
|
Annexure 14
INHERITANCE PATTERN
Autosomal dominant | Autosomal Recessive | X-Linked Disorders |
---|---|---|
|
|
|
MOST COMMON TYPE OF STONES
Most Common Type of Stones | |
---|---|
Gall bladder | CholesterolQ (Mixed if given in the option) |
Pancreas | Calcium carbonateQ |
Kidney | Calcium oxalateQ |
Primary Bladder Stone | Ammonium urateQ |
Secondary Bladder Stone | Uric acid >StruviteQ |
Prostate | Calcium phospahteQ |
Salivary gland (Submandibular) | Calcium carbonateQ |
Annexure 16
NAMED HERNIA
Gibbon's hernia |
|
Berger's hernia |
|
Beclard's hernia |
|
Amyand's hernia |
|
Ogilive's hernia |
|
Stammer's hernia |
|
Peterson hernia |
|
Annexure 17
Ideal time for Treatment
Ideal time for Treatment | |
---|---|
Undesended testis | 6 monthsQ |
Hypospadias | 6–12 monthsQ |
Umbilical hernia | 5 yearsQ |
Cleft lip | 3–6 monthsQ |
Cleft palate | 6–18 monthsQ |
INVESTIGATION OF CHOICE
Investigation of Choice | |
---|---|
Barium swallow | Hiatus herniaQ Zenkers diverticulaQ LeiomyomaQ |
Barium meal | Gastric diverticulaQ |
Barium meal follow-through | Small bowel diverticulaQ |
Enteroclysis | Crohn's diseaseQ |
Barium enema | Colonic diverticulaQ |
CECT | DivericulitisQ GISTQ Mesenteric cystQ GI tuberculosisQ Acute pancreatitisQ Chronic pancreatitisQ Carcinoma pancreasQ Pancreatic pseudocystQ Carcinoma gall bladderQ Hepatocellular carcinomaQ (Triple phase CT) Renal cell carcinomaQ Retroperitoneal fibrosisQ Retroperitoneal sarcomaQ Renal tuberculosisQ ADPKDQ |
MRI | Brain tumorsQ Spinal cord tumorsQ Pancoast tumorQ Soft tissue sarcomaQ Staging of carcinoma penisQ |
Endoscopy with biopsy | Barrett's esophagusQ Carcinoma esophagusQ Carcinoma stomachQ |
Colonoscopy with biopsy | Carcinoma colonQ |
Sigmoidoscopy with bioopsy | Carcinoma rectumQ |
Proctoscopy with biopsy | Carcinoma anal canalQ |
Cystoscopy with biopsy | Carcinoma bladderQ |
FNAC | Carcinoma breastQ Parotid tumorsQ Thyroid malignaniesQ |
Biopsy | Skin malignanciesQ Carcinoma penisQ Oral cavity malignanciesQ |
Manometry | Achalasia cardiaQ Diffuse esophageal spasmQ Nutcrackers esophagusQ |
24-hours pH monitoring | GERDQ |
Somatostatin receptor scintigraphy (IOC for localization) | All neuroendocrine tumors of pancreas except insulinomaQ |
Ultrasound | GallstonesQ Acute cholecystitisQ Chronic cholecystitisQ |
Investigation of Choice | |
---|---|
Acute mesenteric ischemia |
|
Mesenteric venous thrombosis |
|
Chronic mesenteric ischemia |
|
Investigation of Choice | |
---|---|
ADPKD Retroperitoneal Fibrosis | CT scanQ |
Medullary Sponge Kidney | IVPQ |
VUR | MCUQ |
Retrocaval ureter | MRIQ |
PUJ Obstruction | DTPA scanQ |
Renal structure or surface | DMSA scanQ |
Annexure 19
TUMOR MARKERS
Markers | Associated Cancers | Non-neoplastic Conditions |
---|---|---|
Hormones | ||
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Oncofetal Antigens | ||
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Isoenzymes | ||
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|
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Specific proteins | ||
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|
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Mucins and other Glycoproteins | ||
|
|
|
MOST COMMON
Small-Bowel Neoplasm |
---|
|
Liver Neoplasm |
---|
|
|
Indications of Liver Transplantation |
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|
Pediatric Tumors | |
---|---|
| NeuroblastomaQ |
| Wilm's tumorQ |
| Congenital mesoblastic nephromaQ |
| RhabdomyosarcomaQ |
| Brain tumorQ |
| LeukemiaQ (30%) >Brain tumorsQ (22%) |
|
|
|
|
MISCELLANEOUS
|
|
|
|
|
Sarcomas with Lymph Node Metastasis (MARCES) | |
---|---|
|
|
Tumors with Spontaneous Regression (NCR MR) | |
---|---|
|
|
Malignancies associated with Migratory Thrombophlebitis | |
---|---|
|
|
|
Condition | Seen in |
---|---|
Necrolytic erythema migrans |
|
Erythema chronicum migrans |
|
Erythema infectiosum (fifth disease) |
|
Erythema marginatum |
|
Perineural Spread is seen in | |
---|---|
1. Adenoid cystic carcinomaQ 2. CA GBQ 3. CholangiocarcinomaQ | 4. Ductal adenocarcinoma of pancreasQ |
Small Round Blue Cell Tumors (WEL PNR) | |
---|---|
|
|
Causes of Postoperative Fever | |
---|---|
Day | Cause |
2–5 days |
|
3–5 days |
|
5 days |
|
>5 days |
|
|
Increased Cancer Risk in Obese Patients (PEEL CP GO KBC) | ||
---|---|---|
|
|
|
Psammoma Bodies (PSM) |
---|
1. P apillary carcinoma thyroidQ 2. P apillary carcinoma (RCC) Q 3. S erous cystadenomaQ 4. M eningiomaQ |
Proctoscope | 10–12 cmQ |
Rigid sigmoidoscope | 25 cmQ |
Flexible sigmoidoscope | 60 cmQ |
Colonoscope | 160 cmQ |
Most radiosensitive ovarian tumor |
|
Most radiosensitive brain tumor |
|
Most radiosensitive testicular tumor |
|
Most radiosensitive lung tumor |
|
Most radiosensitive kidney tumor |
|
Most radiosensitive bone tumor |
|
Condition | Seen in |
---|---|
Necrolytic erythema migrans |
|
Erythema chronicum migrans |
|
Erythema infectiosum (fifth disease) |
|
Erythema marginatum |
|
Screening Immunohistochemistry |
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