DNB CET Surgery and Allied Clinical Specialties Syllabus

Surgery and Allied Clinical Specialties syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Surgery and Allied Clinical Specialties in DNB CET, not a summary of it.

1. 1

   General Surgery

   5 topics

   • Wound healing, surgical infections and sepsis
   • Fluid, electrolyte and acid-base management
   • GI surgery - hernia, acute abdomen, GI malignancies
   • Breast, thyroid and endocrine surgery
   • Trauma, shock and burns management
2. 2

   Orthopedics and Anesthesia

   4 topics

   • Fractures, dislocations and their complications
   • Bone tumors and infections
   • Preoperative assessment and airway management
   • Local, regional and general anesthesia
3. 3

   Obstetrics and Gynecology

   4 topics

   • Antenatal care and normal labor
   • High-risk pregnancy and obstetric emergencies
   • Contraception and infertility
   • Gynecological malignancies and menstrual disorders
4. 4

   Ophthalmology and ENT

   4 topics

   • Cataract, glaucoma and refractive errors
   • Retinal and corneal disorders
   • Diseases of ear, hearing loss and vertigo
   • Nose, paranasal sinus and throat disorders

Surgery and Allied Clinical Specialties flashcards for DNB CET

21 of 57 cards from the Surgery and Allied Clinical Specialties deck — real questions with worked answers.

1. What are the four overlapping phases of wound healing in correct order?

   Hemostasis, Inflammation, Proliferation (granulation), and Maturation/Remodeling.

2. How do you distinguish healing by primary, secondary, and tertiary (delayed primary) intention?

   Primary: clean wound edges approximated directly (sutured). Secondary: wound left open to heal by granulation, contraction, and epithelialization. Tertiary: wound left open initially (for infection/contamination control) then closed after a few days.

3. Which collagen type predominates early in wound healing versus in the mature scar?

   Type III collagen predominates early; it is gradually replaced by Type I collagen during remodeling, restoring the normal ~4:1 (Type I:III) ratio.

4. What is the maximum tensile strength a healed wound regains, and when?

   A healed wound regains only about 80% of original skin tensile strength, reached at roughly 3 months (60 days onward); it never returns to 100%.

5. Differentiate a hypertrophic scar from a keloid.

   Hypertrophic scar stays within the boundaries of the original wound and often regresses over time. Keloid extends beyond the original wound margins, does not regress, and frequently recurs after excision.

6. What is the SIRS (Systemic Inflammatory Response Syndrome) criteria, and how many are needed for diagnosis?

   Need 2 or more of: Temperature >38C or <36C; Heart rate >90/min; Respiratory rate >20/min or PaCO2 <32 mmHg; WBC >12,000 or <4,000 or >10% bands.

7. How are sepsis and septic shock currently defined (Sepsis-3)?

   Sepsis = life-threatening organ dysfunction from a dysregulated host response to infection (SOFA score increase >=2). Septic shock = sepsis with persistent hypotension requiring vasopressors to keep MAP >=65 mmHg AND serum lactate >2 mmol/L despite adequate fluid resuscitation.

8. What organism most commonly causes necrotizing fasciitis, and what is the definitive treatment?

   Type II (monomicrobial) is typically Group A Streptococcus (S. pyogenes), sometimes with S. aureus; Type I is polymicrobial. Definitive treatment is urgent aggressive surgical debridement plus broad-spectrum antibiotics.

9. What is the normal daily total body water and its compartment distribution?

   Total body water is about 60% of body weight (42 L in a 70 kg man): two-thirds intracellular (~28 L) and one-third extracellular (~14 L), of which ~3 L is plasma (intravascular) and ~11 L is interstitial.

10. State the Holliday-Segar formula for maintenance fluid calculation.

    4 mL/kg/hr for first 10 kg, plus 2 mL/kg/hr for next 10 kg, plus 1 mL/kg/hr for each kg above 20 kg (the 4-2-1 rule).

11. What is the formula for the anion gap and its normal value?

    Anion gap = Na+ - (Cl- + HCO3-). Normal is 8-12 mmol/L (or up to 16 if K+ is included).

12. List common causes of a high anion gap metabolic acidosis (mnemonic).

    MUDPILES: Methanol, Uremia, DKA, Propylene glycol/Paraldehyde, Iron/Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates.

13. What ECG changes are seen in hyperkalemia, in order of progression?

    Tall peaked T waves -> flattened/widened P waves and prolonged PR -> widened QRS -> sine wave pattern -> ventricular fibrillation/asystole.

14. What is the emergency drug treatment of severe hyperkalemia and how does each agent act?

    IV calcium gluconate (cardiac membrane stabilization), insulin with dextrose and beta-agonists (shift K+ into cells), and then removal via diuretics, dialysis, or cation-exchange resins.

15. Differentiate a direct from an indirect inguinal hernia anatomically.

    Indirect hernia passes through the deep inguinal ring, lateral to the inferior epigastric vessels (within the spermatic cord). Direct hernia pushes through the posterior wall of the inguinal canal (Hesselbach's triangle), medial to the inferior epigastric vessels.

16. What are the boundaries of Hesselbach's triangle?

    Medially the rectus abdominis (lateral border), laterally the inferior epigastric vessels, and inferiorly the inguinal ligament.

17. Define an obstructed, incarcerated, and strangulated hernia.

    Incarcerated: irreducible hernia. Obstructed: incarcerated hernia causing bowel obstruction. Strangulated: hernia with compromised blood supply leading to ischemia/necrosis of contents (a surgical emergency).

18. What is the most common cause of mechanical small bowel obstruction in adults versus large bowel obstruction?

    Small bowel obstruction: adhesions (most common), then hernias. Large bowel obstruction: colorectal carcinoma (most common), then volvulus and diverticular disease.

19. Describe the classic pain migration of acute appendicitis.

    Pain begins as periumbilical (visceral, referred to T10) dull pain, then localizes/migrates to the right iliac fossa (McBurney's point) as the parietal peritoneum becomes inflamed (somatic pain).

20. What is the most common type of colorectal cancer and the key genetic pathways?

    Adenocarcinoma is the most common. Key pathways: chromosomal instability (APC -> KRAS -> p53 adenoma-carcinoma sequence) and microsatellite instability (MMR gene defects, as in Lynch syndrome/HNPCC).

21. What tumor marker is used to monitor colorectal cancer recurrence?

    Carcinoembryonic antigen (CEA) - used for monitoring/follow-up, not for screening or diagnosis.

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