General Surgery flashcards for NEET PG

Charcot: fever, jaundice, RUQ pain. Reynolds adds hypotension and altered mental status.

Memory hook: Pentad = sicker.

Papillary carcinoma: Orphan Annie-eye nuclei, psammoma bodies; spreads via lymphatics.

Memory hook: Follicular spreads via blood.

4 mL × kg × %TBSA of Ringer's lactate over 24 h; half in the first 8 h.

Memory hook: Titrate to urine output.

Virchow's: left supraclavicular node. Sister Mary Joseph: umbilical metastasis. Both suggest abdominal malignancy.

Memory hook: Think gastric cancer.

Inguinal: above and medial to the pubic tubercle. Femoral: below and lateral.

Memory hook: Femoral strangulates more.

Inspiratory arrest during palpation of the right upper quadrant, positive in acute cholecystitis.

Memory hook: Pain stops the breath.

A palpable, non-tender gallbladder with jaundice suggests malignant obstruction, such as pancreatic head cancer, rather than gallstones.

Memory hook: Stones scar the gallbladder.

The lesser curvature, near the incisura.

Memory hook: Duodenal ulcers are in the first part.

Symptoms of hypoglycaemia, a low measured glucose, and relief when glucose is given; suggests insulinoma.

Memory hook: Not the Whipple operation.

Immediate needle decompression, then a chest drain.

Memory hook: Clinical diagnosis: do not wait for an X-ray.

A dilated loop shaped like a coffee bean or inverted U arising from the pelvis.

Memory hook: Coffee bean.

Dilated oesophagus with a smooth, tapering 'bird's beak' narrowing at the lower end.

Memory hook: Failure of LES relaxation.

Heller's cardiomyotomy, usually with a partial fundoplication.

Memory hook: Cut the muscle, not the mucosa.

Adenocarcinoma. Squamous cell carcinoma is commoner in the upper and middle thirds.

Memory hook: Barrett's: columnar metaplasia leads to adenocarcinoma.

Spontaneous full-thickness rupture of the lower oesophagus after forceful vomiting.

Memory hook: Mallory-Weiss is a partial mucosal tear.

The junction of the lateral one-third and medial two-thirds of the line from the right anterior superior iliac spine to the umbilicus; maximal tenderness in appendicitis.

Memory hook: Appendix base lies here.

Pain in the right iliac fossa on palpating the left iliac fossa, seen in appendicitis.

Memory hook: Pain refers to the inflamed side.

Familial adenomatous polyposis, with hundreds of colonic adenomas and near-certain cancer without colectomy.

Memory hook: Chromosome 5q.

The terminal ileum, with skip lesions and transmural inflammation.

Memory hook: Crohn's: skip lesions, cobblestoning; UC: continuous from rectum.

Proctocolectomy (restorative, with an ileal pouch-anal anastomosis) cures UC; indications include toxic megacolon, refractory disease and dysplasia.

Memory hook: Crohn's cannot be cured by surgery.

Mixed or cholesterol stones.

Memory hook: Female, fat, fertile, forty.

Ultrasound of the abdomen.

Memory hook: Shows stones and wall thickening.

The cystic duct, the common hepatic duct and the inferior surface of the liver; the cystic artery runs within it.

Memory hook: Identify the critical view of safety before clipping.

The cystic artery, usually a branch of the right hepatic artery.

Memory hook: Seen in Calot's triangle.

MRCP; ERCP is used when therapeutic intervention is also needed.

Memory hook: MRCP diagnoses, ERCP treats.

Periumbilical bruising (Cullen) and flank bruising (Grey Turner) from retroperitoneal haemorrhage in severe acute pancreatitis.

Memory hook: Both are late signs.

Pseudocyst, a collection walled off by granulation or fibrous tissue, not epithelium.

Memory hook: Persistent raised amylase and mass after pancreatitis.

CA 19-9.

Memory hook: Used for monitoring, not screening.

Pancreaticoduodenectomy (Whipple's procedure).

Memory hook: Removes head, duodenum, distal CBD and gallbladder.

Fibroadenoma, a mobile, painless, well-defined 'breast mouse'.

Memory hook: Peak age 15 to 30.

Clinical examination, imaging (ultrasound or mammography) and tissue diagnosis (core biopsy or FNAC).

Memory hook: Three parts: examine, image, sample.

The first draining axillary node, identified using blue dye or radioisotope, used to stage the axilla in early breast cancer.

Memory hook: Negative node avoids full clearance.

Graves' disease, with antibodies stimulating the TSH receptor.

Memory hook: Exophthalmos is specific to Graves'.

Medullary carcinoma; it is associated with MEN 2A and 2B and RET mutations.

Memory hook: Amyloid in stroma.

Follicular carcinoma, diagnosed by capsular or vascular invasion, not cytology.

Memory hook: Needs a lobectomy to diagnose.

Anaplastic carcinoma.

Memory hook: Rapid growth, tracheal compression.

A solitary parathyroid adenoma.

Memory hook: Bones, stones, groans and moans.

Pain, pallor, pulselessness, paraesthesia, paralysis and perishing cold.

Memory hook: Paralysis and paraesthesia signal threatened limb.

Heparin and embolectomy with a Fogarty catheter, or thrombolysis in selected cases.

Memory hook: Embolus often from atrial fibrillation.

Thromboangiitis obliterans, a segmental inflammatory disease of small and medium vessels in young male smokers; stopping smoking is essential.

Memory hook: Rest pain and ulcers in the digits.

Ultrasound of the abdomen.

Memory hook: CT angiography to plan repair.

Stasis, endothelial injury and hypercoagulability.

Memory hook: Predisposes to venous thrombosis.

Calcium oxalate stones.

Memory hook: Radio-opaque on X-ray.

Uric acid stones; they are seen on CT.

Memory hook: Alkalinise urine to dissolve.

Non-contrast CT of the kidneys, ureters and bladder (CT KUB).

Memory hook: Faster, shows stone size and site.

Struvite (magnesium ammonium phosphate) stones.

Memory hook: Urease-splitting organisms raise pH.

Benign prostatic hyperplasia.

Memory hook: Transition zone enlargement.

Transurethral resection of the prostate (TURP).

Memory hook: Complication: TUR syndrome (hyponatraemia).

Haematuria, flank pain and a palpable mass; it is the uncommon full presentation.

Memory hook: Also varicocele on the left side.

Urgent surgical exploration with detorsion and bilateral orchidopexy, ideally within 6 hours.

Memory hook: Prehn's sign negative; do not delay for imaging.

AFP and beta-hCG; seminoma may have mildly raised hCG and LDH but not AFP.

Memory hook: AFP is never raised in pure seminoma.

Airway with cervical spine protection, Breathing, Circulation with haemorrhage control, Disability, Exposure.

Memory hook: ABCDE.

Hypotension, raised jugular venous pressure and muffled heart sounds.

Memory hook: Treat with pericardiocentesis or thoracotomy.

Head and neck 9%, each upper limb 9%, each lower limb 18%, front trunk 18%, back trunk 18%.

Memory hook: Used for estimating %TBSA burned.

Focused assessment with sonography in trauma (FAST); a stable patient gets a contrast CT.

Memory hook: Unstable with positive FAST goes to laparotomy.

Full-thickness (third-degree) burn; it needs excision and skin grafting.

Memory hook: Nerve endings are destroyed.

Range 3 to 15; a score of 8 or less usually needs airway protection.

Memory hook: Eye 4, verbal 5, motor 6.

Indirect inguinal hernia, in both sexes overall.

Memory hook: Lateral to the inferior epigastric vessels.

An indirect hernia passes lateral to the inferior epigastric artery; a direct hernia passes medial to it, through Hesselbach's triangle.

Memory hook: Boundaries: rectus sheath, inguinal ligament, inferior epigastric.

Lichtenstein tension-free mesh repair; laparoscopic TEP or TAPP are alternatives.

Memory hook: Mesh reduces recurrence.

A hernia through a previous surgical scar; wound infection is the commonest risk factor.

Memory hook: Repair with mesh.

Projectile non-bilious vomiting at 2 to 6 weeks of age in a firstborn male with a palpable olive-shaped mass.

Memory hook: Hypochloraemic hypokalaemic metabolic alkalosis.

Ramstedt's pyloromyotomy after correcting fluid and electrolyte imbalance.

Memory hook: Resuscitate before operating.

Double bubble sign; it is associated with Down syndrome.

Memory hook: Bilious vomiting.

Atresia with a distal tracheo-oesophageal fistula (type C).

Memory hook: A nasogastric tube coils in the upper pouch.

Rectal biopsy showing absent ganglion cells and hypertrophic nerve trunks; barium enema shows a transition zone.

Memory hook: Failure to pass meconium within 48 hours.

Pneumatosis intestinalis (gas in the bowel wall), with portal venous gas in severe disease.

Memory hook: Premature neonates.

Orchidopexy at 6 to 12 months, and no later than 18 months.

Memory hook: Untreated increases infertility and malignancy risk.

Within 60 minutes before skin incision, usually as a single dose.

Memory hook: Extend only for long surgery or heavy blood loss.

About 25 to 30 mL per kg per day.

Memory hook: Plus losses and electrolytes.

Haemorrhage (class I to IV based on percentage blood loss).

Memory hook: Class III: 30 to 40% blood loss, hypotension.