About the Book

• Written in question-answer format.
• Contains over 450 questions asked in various university examinations along with their answers.
• Written in simple language and lucid style.
• Helpful for last minute revision before examination.
• The book focuses on the concepts of surgery so that the reader gets the required knowledge.
• Compilation of all university examination questions and answers from authentic references.
• In-depth discussion of all the malignancies in each section for rapid revision.
• Very useful book for undergraduates for exam preparation.

About the Author

Gunjan S Desai MS General Surgery Ronak Patel MD Radiodiagnosis Suhani MS General Surgery Tushit Mewada MCh Neurosurgery (Resident)

Table of Contents:
Section 1: General Surgery 1 Wound Healing 3 ? Mechanisms of wound healing 3 ? Chronic nonhealing of a wound 5 ? Wound dressings 7 ? Pressure sore 9 ? Keloids and hypertrophic scar 11 Fluid, Electrolyte and Acid-Base Imbalance 12 ? Normal water distribution in body 12 ? Hyponatremia 13 ? Hypernatremia 14 ? Hypokalemia 15 ? Hyperkalemia 16 ? Steps of diagnoses of an acid-base disorder 17 ? Metabolic acidoses 18 ? Metabolic alkaloses 19 ? Plasma expanders 19 Metabolism and Nutrition 20 ? Endocrine and metabolic response to stress/ surgery/injury 20 ? Nutritional assessment 23 ? Total parenteral nutrition 24 ? Enteral nutrition 25 Blood Transfusion and dic 27 ? DIC (Disseminated intravascular coagulation) 27 ? Blood “substitutes” 29 ? Blood components 30 ? Complications of blood transfusion 31 ? Plasmapheresis 33 Sirs, Shock and Mods 34 ? Classification of shock 34 ? Septic shock 35 ? MODS (multiple organ dysfunction syndrome) 35 ? Hemmorhagic shock 38 ? Lethal triad 38 Basic of Surgical Technologies and Advanced Surgery 40 ? Minimal access surgery 40 ? Advantages of laparoscopy 40 ? Drawbacks of laparoscopy 40 ? Complications of laparoscopy 40 ? Physiology of pneumoperitoneum 40 ? Diagnostic laparoscopy 43 ? NOTES (natural orifice transluminal endosurgery) 43 ? Therapeutic embolization 45 ? Surgical diathermy 46 ? Photodynamic therapy 48 ? Day case surgery 48 ? Robotic surgery 49 Surgical Infections 50 ? Generalized lymhadenopathy 50 ? Tubercular cervical lymphadenopathy 50 ? Drug-resistant TB 52 ? Ludwig’s angina 53 ? Tetanus 54 ? Gas gangrene 56 ? Carbuncle 57 ? Madura foot 58 ? Anatomy of palmar spaces 59 ? Acute paronychia and felon 61 ? Hydatid cyst 62 ? Entamoeba histolytica 62 ? Actinomycosis 63 Trauma and Damage Control Surgery 65 ? Flail chest 65 ? Disaster management 66 ? “Damage control” in surgery 67 ? Faciomaxillary trauma 69 Perioperative Surgery 72 ? Intraoperative patient monitoring 72 ? Postoperative fever 73 ? Prophylactic antibiotics in surgery 74 ? Probiotics, prebiotics and synbiotics 76 ? Surgical site infection 78 Surgery of the Salivary Glands 81 ? Classification of salivary gland neoplasms 81 ? Pleomorphic adenoma 81 ? Warthin tumor 82 ? Superficial parotidectomy 83 Prelims.indd 13 10-11-2014 11:25:05xiv Exam Preparatory Manual for Undergraduates—Surgery Miscellaneous General Surgery Topics of Importance 85 ? Surgical audit and ethics 85 ? Universal precautions 88 ? FNAC and biopsy 90 ? Sterilization techniques 91 ? Hospital waste management 92 ? Tracheostomy 93 ? Suture materials 94 ? Pain management in surgery 95 Medicine in Surgery 95 ? ARDS 95 ? Diabetic ketoacidosis 99 ? Adrenal insufficiency 102 ? Myxedema coma 105 ? Thyroid storm 108 Section 2: Gastrointestinal, Hepatobiliary and Pancreatic Surgery 111 Esophagus and Diaphragm 113 ? Diaphragmatic hernias 113 ? Portal hypertension 116 ? Esophageal varices 118 ? TIPS 118 ? Achalasia cardia 123 ? Tracheoesophageal fistula 125 ? Barrett’s esophagus 128 ? Gastroesophageal reflux disease 128 ? Zenker’s diverticulum 131 ? Esophageal perforation 133 ? Caustic/corrosive injury in upper GIT 135 Stomach and Duodenum 137 ? Stomach: Relevant anatomy 137 ? Physiology of gastric acid secretion 139 ? Gastric outlet obstruction 140 ? Congenital hypertrophic pyloric stenosis 142 ? H. pylori and peptic ulcer disease 144 ? Postgastrectomy problems 149 ? Upper GI bleeding 150 Small Intestine 151 ? Short bowel syndrome 151 ? Enterocutaneous fistula 153 ? Meckel’s diverticulum 154 ? Intusussception 156 ? Neonatal intestinal obstruction 157 ? Necrotizing enterocolitis 157 ? Meconium ileus 157 ? Mesenteric ischemia 159 ? Superior mesenteric artery syndrome 162 ? Morbid obesity 163 ? Abdominal tuberculosis 165 ? Adult intestinal obstruction 167 Large Intestine 171 ? Inflammatory bowel disease 173 ? Lower GI bleeding 173 ? Sigmoid volvulus 175 ? Diverticulitis (peridiverticulitis) 176 ? Hirschsprung’s disease (congenital megacolon) 177 ? Stomas in surgery 179 Appendix 182 ? Alvarado score and its significance 182 ? Types of appendicitis 182 ? Appendicular lump 184 Rectum and Anal Canal 185 ? Anatomy of anal canal 185 ? Blood supply of the rectum 186 ? Fissure-in-ano 187 ? Fistula-in-ano 189 ? Pilonidal disease 191 ? Rectal prolapse 192 ? Hemorrhoids 193 ? Anorectal malformations 195 ? Ischiorectal abscess 197 Liver 198 ? Anatomy of liver 198 ? Cystic lesions of liver 201 ? Amoebic liver abscess 202 ? Liver transplantation 204 ? Liver injury 205 Gallbladder and Bile Duct 206 ? Gallstones and complications 206 ? Cholecystitis 207 ? Obstructive jaundice 210 ? Postcholecystectomy problems 213 ? Choledochal cyst 216 ? Hemobilia and bilhemia 217 ? Choledocholithiases 218 ? Biliary strictures 220 ? Courvoisier’s law 220 Prelims.indd 14 10-11-2014 11:25:05Contents xv Pancreas 220 ? Annular pancreas 220 ? Acute pancreatitis 221 ? Pseudocyst pancreas 224 ? Insulinoma 225 ? Prognostic scoring in pancreatitis 226 ? Cystic pancreatic neoplasms 228 ? Pancreatic duct disruption 230 Spleen 231 ? Hypersplenism 231 ? Splenic injury 232 ? OPSI 234 ? Complications after splenectomy 234 Hernias 235 ? Meshes in hernia surgery 235 ? Incisional hernia 237 ? Anatomy of umbilicus 239 ? Umbilical hernia 240 ? Open and laparoscopic anatomy of inguinal region 243 ? Direct and indirect hernia 247 ? Femoral hernia 251 Gastrointestinal Oncosurgery 253 ? Esophageal cancer 253 ? Carcinoma stomach 255 ? GE junction tumors 258 ? Small bowel adenocarcinoma 259 ? Carcinoid tumor 259 ? Gastrointestinal stromal tumor 263 ? Colorectal cancer 265 ? Carcinoma anal canal 271 ? Hepatocellular carcinoma 271 ? Carcinoma gallbladder 273 ? Cholangiocarcinoma 276 ? Pancreatic cancer 277 ? Pseudomyxoma peritonei 278 Miscellaneous 280 ? Burst abdomen 280 ? Peritonitis 282 ? Mesenteric cyst 283 Section 3: Genitourology 285 Kidney and Ureter 287 ? Renal calculi 287 ? Calculus anuria 289 ? ESWL 291 ? PCNL 292 ? Percutaneous nephrostomy 293 ? Urinary diversion 293 ? Renal TB 294 ? Renal trauma 297 ? Hematuria 300 ? Pyelonephritis 302 ? Pyonephrosis 304 ? Hydronephrosis 304 ? Wilms’ tumor 305 ? Horse shoe kidney 307 ? PUJ obstruction 308 ? Classification of renal lumps 309 Urinary Bladder 311 ? Bladder calculi 311 ? Bladder injury 312 ? Vesicovaginal fistula 313 ? Micturition reflex 315 ? Neurogenic bladder 315 ? Incontinence 317 ? Chyluria 318 ? Vesicoureteric reflux 319 ? Ectopia vesicae 320 Prostate 321 ? LUTS 322 ? Benign prostatic hypertrophy 322 ? TURP 322 ? Postoperative urinary retention 325 ? PSA 327 Testis and Scrotum 328 ? Development of testis 328 ? Cryptorchidism 328 ? Testicular torsion 330 ? Epididymoorchitis 332 ? Varicocele 333 ? Hydrocele 334 ? Fournier’s gangrene 334 ? Differential diagnoses of a scrotal swelling 335 ? Phimoses and paraphimoses 336 ? Vasectomy 337 ? Circumcision 338 Penis and Urethra 339 ? Penile ulcer 339 ? Urethral injury 340 ? Urethral stricture 342 ? Lasers in urology 343 ? Posterior urethral valve 344 ? Proteinuria 345 Prelims.indd 15 10-11-2014 11:25:05xvi Exam Preparatory Manual for Undergraduates—Surgery ? Male infertility 346 ? Development of genitourinary tract 348 ? Hypospadias 350 Uro-oncology 351 ? Renal cell carcinoma 351 ? Urinary bladder cancer 355 ? Carcinoma testis 357 ? Carcinoma penis 361 ? Carcinoma prostate 364 Section 4: Neurosurgery 367 ? Physiology of CSF and its circulation 369 ? Hydrocephalus 369 ? Criteria for brain death 373 ? Head injury pathophysiology 374 ? Glasgow coma scale (GCS) 376 ? Monitoring of a head injury patient 376 ? CT scan in a patient with head injury 376 ? Management of head injury 378 ? Epidural hematomas 380 ? Subdural hematoma 382 ? Spina bifida 384 ? Functional neurosurgery 386 ? Stereotactic surgery 387 ? Neurofibroma 389 ? Intracranial space occupying lesions 390 Section 5: Cardiothoracic and Vascular Surgery 393 Cardiac and Thoracic Surgery 395 ? Empyema thoracis 395 ? Pneumothorax 396 ? Hemothorax 398 ? Cardiac tamponade 399 ? Cardiac arrest 400 ? Intercostal drainage 401 Peripheral Arterial Disease for Lower Limb 403 ? Anatomy 403 ? Risk factors 403 ? Clinical features and investigations 404 ? Acute lower limb ischemia 404 ? Gangrene 408 ? Management 409 ? Critical limb ischemia 409 ? Buerger disease 411 ? Amputation 412 ? Sympathectomy 414 ? Omental transfer operations 414 ? Endovascular management 415 ? Diabetic foot 416 Peripheral Venous Diseases 419 ? Anatomy 419 ? Varicose veins 420 ? Deep vein thrombosis 424 ? Raynaud phenomenon 425 Miscellaneuos Topics In CTVS 426 ? Thoracic outlet syndrome 426 ? Lymphedema of lower limb 426 ? Hodgkin’s and non-Hodgkin’s lymphoma 430 ? Unilateral lower limb edema 431 Section 6: Breast and Endocrine Surgery 435 Breast 437 ? Blood supply and lymphatic drainage 437 ? Nipple discharge 438 ? ANDI (Aberrations of normal development and involution) 440 ? Mammary duct ectasia 441 ? Phylloides tumor 441 ? Paget’s disease of nipple 442 ? Gynecomastia 443 ? LCIS and DCIS 444 ? Triple breast assessment 446 ? Risk factors for breast cancer 446 ? Breast conservative surgery 447 ? Management of locally advanced breast cancer 449 ? Breast reconstruction 451 Thyroid 454 ? Embryology of thyroid and parathyroid 454 ? Thyroglossal cyst and fistula 455 ? Classification of thyroid swellings 456 ? Papillary thyroid cancer 457 ? Follicular thyroid cancer 459 ? Medullary thyroid cancer 460 ? Solitary thyroid nodule 461 ? Grave’s disease 462 ? Complications of thyroidectomy 464 Parathyroid and Adrenal 465 ? Primary hyperparathyroidism 465 ? Adrenal incidentaloma 466 Prelims.indd 16 10-11-2014 11:25:05Contents xvii Section 7: Surgical Radiology 469 ? Computed tomography (CT) 471 ? Ultrasound 473 ? Doppler ultrasound 476 ? Magnetic resonance imaging (MRI) 478 ? PET scan 481 ? Intravenous pyelography (IVP) 484 ? Micturating cystourethrogram (MCU) 487 ? ERCP 488 ? MRCP 491 ? Radioisotope bone scan 493 ? Thyroid scan 496 ? DMSA and DTPA scan 499 ? Mammography and BIRADS 502 ? FAST 503 ? Radiological features of acute intestinal obstruction 510 ? Barium swallow in esophageal disorders 513 Section 8: Miscellaneous 523 Anesthesia 525 ? Pre-anesthetic medication 525 ? ASA grade 525 ? Muscle relaxants 526 ? Mivacurium 526 ? Succinylcholine 526 ? Regional anesthesia 528 ? Spinal regional anesthesia 530 ? Local anesthetic drugs 530 ? Epidural anesthesia 531 ? Epidural analgesia 531 ? Brachial plexus block 533 ? Caudal block 533 ? Cervical blocks 534 ? Nerve block and field block 535 ? General anesthetic drugs 535 ? Halothane 535 ? Propofol 535 ? Postoperative ventilation 537 ? Complications of general anesthesia 538 ? Central venous pressure monitoring 539 Skin 540 ? Premalignant skin lesions 540 ? Squamous cell cancer 540 ? Basal cell carcinoma 541 ? Pigmented nevus 546 ? Melanocytic nevi 546 ? Malignant melanoma 547 Burns and Plastic Surgery 549 ? Skin grafts and flaps 549 ? Phases of ‘take’ of graft 549 ? Types of burns 553 ? Assessment of burns 553 ? Prehospital care 554 ? 40% TBSA burns management 554 ? Inhalational injuries in a burn patient 554 ? Pathophysiology of thermal burns 557 ? Development of lip and palate 558 ? Cleft lip and cleft palate 558 Head and Neck Surgery 560 ? Anatomy of neck 560 ? Epulis 562 ? Adamantinoma 562 ? Premalignant lesions of the oral cavity 564 ? Cystic hygroma 565 ? Hemangioma 566 ? Branchial cyst and fistula 567 ? Ranula 568 Oncosurgery Basics 569 ? Immunotherapy in cancer 569 ? Immunosupressants drugs 571 ? Cancer prevention 573 ? Tumor markers 574 ? Oncogenes 575 ? Tumor suppressor genes 576 ? Sacrococcygeal teratoma 577