AIIMS PG (DM/MCh) Entrance General Surgery and Surgical Super-Specialties Syllabus

General Surgery and Surgical Super-Specialties syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for General Surgery and Surgical Super-Specialties in AIIMS PG (DM/MCh) Entrance, not a summary of it.

1. 1

   Gastrointestinal and Hepatobiliary Surgery

   4 topics

   • Esophagus and Stomach
     • Esophageal and gastric carcinoma surgery
     • Bariatric and anti-reflux procedures
   • Hepatobiliary and Pancreatic Surgery
     • Whipple procedure and pancreatic resections
     • Liver resection and biliary reconstruction
   • Colorectal Surgery
     • Colorectal cancer staging and resection
     • Anorectal disorders and stomas
   • Acute Abdomen and Trauma
     • Peritonitis and bowel obstruction
     • Damage control surgery principles
2. 2

   Cardiothoracic and Vascular Surgery

   4 topics

   • Coronary and Valve Surgery
     • CABG techniques and conduits
     • Valve repair and replacement
   • Congenital Heart Surgery
     • Acyanotic and cyanotic lesion repairs
     • Cardiopulmonary bypass principles
   • Thoracic Surgery
     • Lung resection and mediastinal masses
     • Empyema and chest wall disorders
   • Vascular Surgery
     • Aortic aneurysm and dissection
     • Peripheral arterial disease and limb ischemia
3. 3

   Neurosurgery

   4 topics

   • Neuro-oncology
     • Gliomas, meningiomas and pituitary tumors
     • Posterior fossa and skull base tumors
   • Vascular Neurosurgery
     • Aneurysm clipping and coiling
     • Arteriovenous malformations
   • Spine and Trauma
     • Traumatic brain injury management
     • Spinal cord injury and degenerative spine
   • Functional and Pediatric Neurosurgery
     • Hydrocephalus and shunt procedures
     • Epilepsy and movement disorder surgery
4. 4

   Urology

   4 topics

   • Uro-oncology
     • Renal cell and urothelial carcinoma
     • Prostate and bladder cancer management
   • Endourology and Stone Disease
     • Urolithiasis evaluation and PCNL/URS
     • Benign prostatic hyperplasia procedures
   • Reconstructive and Functional Urology
     • Urinary diversion and reconstruction
     • Neurogenic bladder and incontinence
   • Andrology and Transplantation
     • Male infertility and erectile dysfunction
     • Renal transplant surgical aspects
5. 5

   Plastic and Surgical Oncology

   3 topics

   • Reconstructive Surgery
     • Skin grafts and flap principles
     • Microvascular free tissue transfer
   • Burns and Wound Management
     • Burn resuscitation and assessment
     • Chronic wound and pressure ulcer care
   • Surgical Oncology Principles
     • Tumor biology and margins
     • Breast and head-neck oncosurgery

General Surgery and Surgical Super-Specialties flashcards for AIIMS PG (DM/MCh) Entrance

21 of 51 cards from the General Surgery and Surgical Super-Specialties deck — real questions with worked answers.

1. In a patient with achalasia cardia, what is the classic finding on barium swallow and the gold-standard diagnostic test?

   Barium swallow shows a smooth, tapering 'bird-beak' narrowing at the gastro-esophageal junction with proximal dilatation. High-resolution esophageal manometry is the gold standard (absent peristalsis with failure of LES relaxation).

2. What is the surgical treatment of choice for achalasia and what is added to prevent reflux?

   Laparoscopic Heller cardiomyotomy, combined with a partial (usually Dor anterior) fundoplication to prevent postoperative gastro-esophageal reflux.

3. Describe Siewert classification of gastro-esophageal junction adenocarcinoma.

   Based on tumor epicenter relative to the cardia: Type I = 1–5 cm above; Type II = 1 cm above to 2 cm below (true cardia); Type III = 2–5 cm below the GEJ.

4. What is the most common site of perforation in peptic ulcer disease and the most common cause of upper GI bleeding from a gastric ulcer?

   Anterior wall of the first part of the duodenum is the most common perforation site; bleeding gastric ulcers most commonly erode the left gastric artery, while posterior duodenal ulcers erode the gastroduodenal artery.

5. Define the triad of Zollinger-Ellison syndrome and its associated MEN syndrome.

   Gastrinoma causing massive gastric acid hypersecretion, severe/refractory/atypical peptic ulcers, and diarrhea. Associated with MEN-1 (parathyroid, pancreas, pituitary). Most gastrinomas arise in the 'gastrinoma triangle'.

6. What are the Milan criteria for liver transplantation in hepatocellular carcinoma?

   Single tumor ≤5 cm, OR up to 3 tumors each ≤3 cm, with no macrovascular invasion and no extrahepatic spread.

7. State Charcot's triad and Reynolds' pentad for ascending cholangitis.

   Charcot's triad: fever with chills, right upper quadrant pain, and jaundice. Reynolds' pentad adds hypotension (septic shock) and altered mental status (confusion).

8. What is Courvoisier's law and its clinical significance?

   In a jaundiced patient, a palpable, non-tender gallbladder is unlikely to be due to gallstones and suggests malignant obstruction of the common bile duct (e.g., periampullary/pancreatic head carcinoma).

9. What operation is the Whipple procedure and what does it resect?

   Pancreaticoduodenectomy for periampullary/pancreatic head tumors. It resects the head of the pancreas, duodenum, distal stomach (classic) or pylorus-preserving, gallbladder, common bile duct, and proximal jejunum, with three anastomoses (pancreatico-, hepatico-, and gastro-/duodeno-jejunostomy).

10. List the modified Atlanta classification of acute pancreatitis severity.

    Mild (no organ failure, no local/systemic complications); Moderately severe (transient organ failure <48 h and/or local complications); Severe (persistent organ failure >48 h).

11. What is the Bismuth-Corlette classification used for?

    It classifies hilar cholangiocarcinoma (Klatskin tumor) by location relative to the biliary confluence: Type I below confluence, II at confluence, IIIa/IIIb extending into right/left hepatic duct, IV bilateral second-order ducts or multifocal.

12. What is the most common site of colorectal cancer and the staging system used?

    The rectum and sigmoid colon are the most common sites. TNM staging is standard; the older Dukes classification (A confined to bowel wall, B through wall, C nodal, D distant metastasis) is also referenced.

13. Differentiate ulcerative colitis from Crohn's disease in terms of distribution and depth.

    UC: continuous, mucosal/submucosal inflammation starting at the rectum, confined to colon, no skip lesions, no fistulae. Crohn's: transmural, anywhere mouth-to-anus with skip lesions, granulomas, fistulae, strictures, and 'cobblestoning'.

14. What is the total mesorectal excision (TME) principle in rectal cancer surgery?

    En-bloc removal of the rectum within its intact mesorectal fascial envelope, preserving the autonomic nerves; it minimizes circumferential margin involvement and dramatically reduces local recurrence.

15. Name the four cardinal features used in the Hinchey classification.

    Hinchey classifies perforated diverticulitis: I pericolic/mesenteric abscess; II walled-off pelvic abscess; III generalized purulent peritonitis; IV generalized feculent peritonitis.

16. What is the most common cause of large bowel obstruction and the most common cause of small bowel obstruction?

    Colorectal carcinoma is the most common cause of large bowel obstruction; postoperative adhesions are the most common cause of small bowel obstruction.

17. Describe the typical migration pattern of pain in acute appendicitis and McBurney's point.

    Pain begins as vague periumbilical (visceral) discomfort and later localizes to the right iliac fossa (somatic). McBurney's point lies at the junction of the lateral one-third and medial two-thirds of a line from the ASIS to the umbilicus.

18. In trauma, what are the components of the FAST examination and what does it detect?

    Focused Assessment with Sonography for Trauma examines four windows—perihepatic (Morrison's pouch), perisplenic, pelvic (pouch of Douglas), and pericardial (subxiphoid)—to detect free intraperitoneal fluid/blood and pericardial effusion.

19. What defines the 'lethal triad' (trauma triad of death)?

    Hypothermia, metabolic acidosis, and coagulopathy—a self-perpetuating cycle in severely injured patients that justifies damage-control surgery.

20. What is Beck's triad and which condition does it indicate?

    Hypotension, muffled/distant heart sounds, and distended neck veins (raised JVP)—indicating acute cardiac tamponade.

21. In coronary artery bypass grafting, which conduit has the best long-term patency and why?

    The left internal mammary (thoracic) artery grafted to the LAD has the best long-term patency (>90% at 10 years) due to its arterial wall structure and resistance to atherosclerosis.

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