DNB CET Surgery and Allied Clinical Specialties Syllabus

What tumor marker is used to monitor colorectal cancer recurrence?

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

What is the most common type of breast cancer and the most common benign breast tumor?

Most common malignant: Invasive ductal carcinoma (NST). Most common benign tumor: Fibroadenoma (typically in young women, mobile 'breast mouse').

What is the triple assessment for a breast lump?

Clinical examination, Imaging (mammography and/or ultrasound), and Pathology (FNAC or core needle biopsy).

Which receptors are tested in breast cancer and why?

ER (estrogen) and PR (progesterone) receptors - predict response to hormonal therapy (e.g. tamoxifen); HER2/neu - predicts response to trastuzumab. Triple-negative (ER-/PR-/HER2-) has poorer prognosis.

What is the most common cause of hyperthyroidism, and its characteristic eye finding?

Graves' disease (autoimmune, anti-TSH receptor antibodies). Characteristic feature is exophthalmos (Graves' ophthalmopathy), along with pretibial myxedema and diffuse goiter.

What nerve is at risk during thyroidectomy and what is the consequence of injury?

The recurrent laryngeal nerve. Unilateral injury causes hoarseness; bilateral injury can cause airway obstruction/stridor requiring tracheostomy. The external branch of the superior laryngeal nerve injury affects voice pitch (cricothyroid muscle).

What is the most common type of thyroid cancer and its mode of spread?

Papillary thyroid carcinoma (most common, ~80%); spreads via lymphatics, has excellent prognosis. Follicular carcinoma spreads hematogenously; medullary arises from parafollicular C cells (secretes calcitonin).

Classify hemorrhagic shock by ATLS class based on blood loss percentage.

Class I: <15% (up to ~750 mL), normal vitals. Class II: 15-30% (750-1500 mL), tachycardia, narrowed pulse pressure. Class III: 30-40% (1500-2000 mL), hypotension, altered mental state. Class IV: >40% (>2000 mL), severe hypotension, lethargy/obtundation.

Name the four types of shock and the underlying mechanism of each.

Hypovolemic (loss of intravascular volume), Cardiogenic (pump failure), Distributive (vasodilation - septic/anaphylactic/neurogenic), and Obstructive (mechanical obstruction - tension pneumothorax, cardiac tamponade, massive PE).

State the Parkland (Baxter) formula for burns fluid resuscitation.

4 mL x body weight (kg) x %TBSA burned = total Ringer's lactate in first 24h; give half in the first 8 hours (from time of burn) and the remaining half over the next 16 hours.

How is burn depth classified and which degree is most painful?

Superficial (1st degree, epidermis only - red, painful), Superficial partial-thickness (2nd, painful, blisters), Deep partial-thickness (2nd, less painful), Full-thickness (3rd, painless, white/leathery), 4th degree (into muscle/bone). Superficial partial-thickness is the most painful.

How is total body surface area (TBSA) of burns estimated in an adult?

Wallace's Rule of Nines: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%. Patient's palm (including fingers) is about 1% TBSA.

Define the Salter-Harris classification of physeal (growth plate) fractures.

Type I: through physis. Type II: through physis + metaphysis (most common). Type III: through physis + epiphysis. Type IV: through metaphysis, physis, and epiphysis. Type V: crush injury to physis (worst prognosis). Mnemonic SALTR.

What is a Colles' fracture and its characteristic deformity?

A fracture of the distal radius (within ~2.5 cm of the wrist) with dorsal angulation/displacement of the distal fragment, producing the classic 'dinner fork' deformity. Typically from a fall on an outstretched hand.

What are the components of compartment syndrome (the 6 Ps), and the definitive treatment?

Pain (out of proportion, especially on passive stretch), Paresthesia, Pallor, Pulselessness (late), Paralysis, Poikilothermia. Definitive treatment is emergency fasciotomy.

Which fractures are notorious for avascular necrosis due to retrograde blood supply?

Scaphoid (proximal pole), femoral neck (head of femur), talus body, and humeral head fractures - all have a vulnerable retrograde blood supply.

Differentiate Volkmann's ischemic contracture and its common cause.

It is a permanent flexion contracture of the wrist and fingers from ischemic necrosis of forearm flexor muscles, classically following untreated compartment syndrome after a supracondylar fracture of the humerus in children.

What is the most common primary malignant bone tumor and its classic radiographic sign?

Osteosarcoma (most common primary bone malignancy, typically around the knee in adolescents). Radiographic signs: Codman's triangle and 'sunburst/sunray' periosteal reaction.

Contrast Ewing's sarcoma and osteosarcoma radiologically.

Ewing's sarcoma shows an 'onion-skin' (lamellated) periosteal reaction, typically in the diaphysis of long bones in children, with t(11;22) translocation. Osteosarcoma shows sunburst pattern and Codman's triangle, typically in the metaphysis.

What is the most common benign bone tumor, and what is a giant cell tumor's typical location?

Osteochondroma is the most common benign bone tumor. Giant cell tumor (osteoclastoma) is locally aggressive, typically at the epiphysis/metaphysis of long bones (e.g. distal femur), with a 'soap bubble' radiographic appearance.

What organism most commonly causes acute osteomyelitis, and what about in sickle cell disease?

Staphylococcus aureus is the most common cause overall. In sickle cell disease, Salmonella is characteristically implicated (though S. aureus is still common).

Describe the ASA Physical Status classification system.

ASA I: normal healthy patient. ASA II: mild systemic disease. ASA III: severe systemic disease (not incapacitating). ASA IV: severe systemic disease that is a constant threat to life. ASA V: moribund, not expected to survive without surgery. ASA VI: brain-dead organ donor. 'E' suffix for emergency.

What is the Mallampati classification used for, and what do the classes indicate?

It predicts difficulty of intubation by visualization of oropharyngeal structures. Class I: soft palate, uvula, fauces, pillars visible. Class II: soft palate, uvula, fauces. Class III: soft palate, base of uvula. Class IV: only hard palate visible (most difficult).

What is the recommended preoperative fasting guideline (2-4-6-8 rule)?

2 hours for clear fluids, 4 hours for breast milk, 6 hours for light meal/formula/non-human milk, 8 hours for a heavy/fatty meal.

Name the mechanism and antidote toxicity sign of local anesthetics, and the maximum dose of lidocaine.

Local anesthetics block voltage-gated Na+ channels. LAST (local anesthetic systemic toxicity) causes CNS (perioral numbness, seizures) then cardiac effects; treated with IV lipid emulsion. Max lidocaine dose ~3 mg/kg (plain) or ~7 mg/kg with adrenaline.

Differentiate spinal from epidural anesthesia.

Spinal: single injection into the subarachnoid (intrathecal) space below L2, small drug dose, rapid dense block. Epidural: catheter into epidural space (outside dura), larger volume, slower onset, allows continuous/titratable dosing, used at any spinal level.

What are the components of the triad of general anesthesia?

Hypnosis (unconsciousness), Analgesia (pain relief), and Muscle relaxation (akinesia); sometimes amnesia and autonomic stability are also cited.

What is the recommended schedule of antenatal visits and the definition of term pregnancy?

WHO recommends at least 8 antenatal contacts. Term is 37 to <42 weeks (early term 37-38, full term 39-40, late term 41). Pre-term is <37 weeks; post-term is >=42 weeks.

Describe the three stages of normal labor.

First stage: onset of true labor to full cervical dilatation (10 cm) - includes latent and active phases. Second stage: full dilatation to delivery of the baby. Third stage: delivery of baby to expulsion of the placenta.

What blood pressure and proteinuria define pre-eclampsia, and what defines eclampsia?

Pre-eclampsia: new-onset BP >=140/90 mmHg after 20 weeks plus proteinuria (>=300 mg/24h) or end-organ dysfunction. Eclampsia: pre-eclampsia with new-onset generalized tonic-clonic seizures. Magnesium sulfate is the drug of choice for seizure prophylaxis/treatment.

What is the most effective reversible contraceptive method, and what is the mechanism of combined oral contraceptive pills?

LARC (long-acting reversible contraception) such as IUDs and implants are most effective. Combined OCPs (estrogen + progestin) primarily inhibit ovulation by suppressing the LH surge, plus thickening cervical mucus and thinning the endometrium.

What HPV-related cancer is the most common gynecological malignancy globally, and what is the screening test?

Cervical cancer (most are squamous cell carcinoma caused by HPV 16 and 18). Screening is by Pap smear (cervical cytology) and/or HPV DNA testing; prevented by HPV vaccination.

Differentiate open-angle and angle-closure glaucoma, and which is an emergency.

Primary open-angle glaucoma: chronic, painless, gradual peripheral visual field loss with raised IOP and open angle. Acute angle-closure glaucoma: sudden painful red eye, halos around lights, fixed mid-dilated pupil, very high IOP - an ophthalmic emergency.

Contrast the clinical presentation of immature cataract and the pathology of diabetic retinopathy's proliferative stage.

Cataract is opacification of the lens causing painless progressive blurring/glare. Proliferative diabetic retinopathy is defined by neovascularization (new fragile vessels) due to retinal ischemia, risking vitreous hemorrhage and retinal detachment; treated with laser photocoagulation/anti-VEGF.

Differentiate conductive from sensorineural hearing loss using Rinne and Weber tests.

Conductive loss: Rinne negative (bone > air conduction) in affected ear; Weber lateralizes TO the affected ear. Sensorineural loss: Rinne positive (air > bone, but both reduced); Weber lateralizes AWAY from the affected ear (to the better ear).

Differentiate the three peripheral causes of vertigo: BPPV, Meniere's disease, and vestibular neuritis.

BPPV: brief positional vertigo (seconds) from canaliths, treated with Epley maneuver. Meniere's: episodic vertigo (minutes-hours) with fluctuating sensorineural hearing loss, tinnitus, and aural fullness (endolymphatic hydrops). Vestibular neuritis: acute prolonged vertigo (days) without hearing loss, usually post-viral.

What is the most common cause of unilateral nasal obstruction with foul discharge in a child, versus the most common benign nasopharyngeal tumor in adolescent males?

Unilateral foul nasal discharge in a child suggests a nasal foreign body. The most common benign but highly vascular nasopharyngeal tumor in adolescent males is juvenile nasopharyngeal angiofibroma (presents with recurrent epistaxis and obstruction).