MBBS Surgery Syllabus

Surgery syllabus — full chapter and topic list

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

1. 1

   General Surgery

   3 topics

   • Principles of surgery
     • Aseptic technique
     • Surgical instruments
     • Wound healing
     • Surgical complications
   • Preoperative evaluation
     • Patient assessment
     • Informed consent
     • Preoperative optimization
     • Risk stratification
   • Postoperative care
     • Monitoring
     • Pain management
     • Wound care
     • Prevention of surgical site infections
2. 2

   Gastrointestinal Surgery

   4 topics

   • Abdominal wall hernias
     • Inguinal hernia
     • Femoral hernia
     • Umbilical hernia
     • Incisional hernia
   • Esophageal disorders
     • Gastroesophageal reflux disease (GERD)
     • Esophageal cancer
     • Achalasia
     • Esophageal diverticula
   • Gastric and duodenal disorders
     • Peptic ulcer disease
     • Gastric cancer
     • Duodenal diverticula
   • Colorectal disorders
     • Colorectal cancer
     • Diverticular disease
     • Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
     • Anorectal disorders (hemorrhoids, anal fissures)
3. 3

   Hepatobiliary Surgery

   3 topics

   • Gallbladder diseases
     • Cholelithiasis
     • Cholecystitis
     • Gallbladder polyps
     • Gallbladder cancer
   • Liver diseases
     • Hepatocellular carcinoma
     • Liver abscess
     • Hepatic cysts
     • Liver transplantation
   • Pancreatic diseases
     • Pancreatitis
     • Pancreatic cancer
     • Pancreatic pseudocysts
     • Pancreatic neuroendocrine tumors
4. 4

   Endocrine Surgery

   3 topics

   • Thyroid disorders
     • Thyroid nodules
     • Thyroid cancer
     • Graves' disease
     • Thyroidectomy
   • Parathyroid disorders
     • Primary hyperparathyroidism
     • Parathyroid adenoma
     • Parathyroidectomy
   • Adrenal disorders
     • Adrenal incidentaloma
     • Adrenal adenoma
     • Adrenal carcinoma
     • Adrenalectomy
5. 5

   Breast Surgery

   2 topics

   • Benign breast disorders
     • Fibroadenoma
     • Fibrocystic changes
     • Breast cysts
     • Breast pain
   • Breast cancer
     • Diagnosis
     • Staging
     • Lumpectomy
     • Mastectomy
     • Breast reconstruction
6. 6

   Vascular Surgery

   3 topics

   • Arterial diseases
     • Atherosclerosis
     • Peripheral arterial disease (PAD)
     • Abdominal aortic aneurysm (AAA)
     • Carotid artery disease
   • Venous diseases
     • Varicose veins
     • Deep vein thrombosis (DVT)
     • Venous insufficiency
     • Venous ulcers
   • Vascular access
     • Central venous catheterization
     • Arteriovenous fistula (AVF)
     • Arteriovenous graft (AVG) creation for hemodialysis
7. 7

   Trauma Surgery

   3 topics

   • Evaluation and management of trauma patients
     • Primary survey (ABCDE approach)
     • Secondary survey
     • Management of life-threatening injuries
   • Traumatic brain injury
     • Head injury classification (Glasgow Coma Scale, Traumatic Brain Injury Severity Score)
     • Intracranial hemorrhage
     • Surgical interventions (craniotomy, craniectomy)
   • Abdominal trauma
     • Blunt abdominal trauma
     • Penetrating abdominal trauma
     • Solid organ injuries (liver, spleen)
     • Hollow viscus injuries (bowel perforation)
8. 8

   Orthopedic Surgery

   3 topics

   • Fractures and Dislocations
     • Principles of fracture management (reduction, fixation)
     • Closed fractures
     • Open fractures
     • Common fractures
   • Joint Replacement Surgery
     • Total hip replacement (THR)
     • Total knee replacement (TKR)
     • Shoulder arthroplasty
   • Spine Surgery
     • Degenerative spine disorders
     • Spinal fusion
     • Laminectomy
9. 9

   Renal and ureteric disorders

   4 topics

   • Renal stones
   • Renal cell carcinoma
   • Ureteropelvic junction (UPJ) obstruction
   • Ureteral strictures
10. 10

    Pediatric Surgery

    2 topics

    • Neonatal surgery
      • Congenital anomalies (gastroschisis, omphalocele)
      • Congenital diaphragmatic hernia (CDH)
      • Esophageal atresia
    • Pediatric abdominal surgery
      • Appendicitis
      • Intussusception
      • Hirschsprung's disease
      • Pediatric tumors (Wilms tumor, neuroblastoma)

Surgery flashcards for MBBS

18 of 58 cards from the Surgery deck — real questions with worked answers.

1. What are the five classic cardinal signs of acute inflammation relevant to surgical wound assessment?

   Rubor (redness), calor (heat), tumor (swelling), dolor (pain), and functio laesa (loss of function).

2. State the surgical wound classification system and give an example of each class.

   Class I Clean (e.g., elective thyroidectomy, no viscus entered); Class II Clean-contaminated (e.g., elective cholecystectomy, controlled viscus entry); Class III Contaminated (e.g., gross spillage, fresh traumatic wound); Class IV Dirty/Infected (e.g., perforated viscus, established pus).

3. What does the ASA physical status classification assess, and what does ASA III mean?

   It grades a patient's preoperative physical status/fitness for anesthesia. ASA I = healthy; II = mild systemic disease; III = severe systemic disease that is not incapacitating; IV = severe disease that is a constant threat to life; V = moribund, not expected to survive 24 h without surgery; VI = brain-dead organ donor.

4. In preoperative cardiac risk assessment, what is a MET and what threshold suggests adequate functional capacity?

   A MET (metabolic equivalent of task) is the resting oxygen consumption ($\approx 3.5\,\text{mL O}_2\,\text{kg}^{-1}\,\text{min}^{-1}$). The ability to achieve $\geq 4$ METs (e.g., climbing two flights of stairs) indicates adequate functional capacity and lower perioperative risk.

5. When should chronic antiplatelet/anticoagulant agents typically be stopped before elective major surgery: clopidogrel and warfarin?

   Clopidogrel is usually stopped about 5-7 days preoperatively; warfarin is stopped about 5 days preoperatively (allowing INR to fall to $< 1.5$), with bridging anticoagulation considered in high-thrombotic-risk patients.

6. What is the standard preoperative fasting guideline (ASA) for clear liquids and for solid food?

   Clear liquids may be taken up to 2 hours before anesthesia; a light meal/solids require at least 6 hours of fasting (8 hours for fatty/fried foods or meat).

7. List the components of the modified Apgar/Aldrete-style postoperative recovery concerns by recalling the 'most common cause' of fever on each postoperative day mnemonic (5 W's).

   Wind (atelectasis/pneumonia, days 1-2), Water (urinary tract infection, days 3-5), Wound (surgical site infection, days 5-7), Walking (deep vein thrombosis, days 5+), Wonder drugs (drug fever/transfusion, anytime).

8. What is the most common cause of fever within the first 24-48 hours after surgery?

   Atelectasis (collapse of alveoli), typically due to shallow breathing and retained secretions; treated with incentive spirometry, chest physiotherapy, and early mobilization.

9. Define a postoperative ileus and give the typical order of return of bowel motility after laparotomy.

   Postoperative ileus is transient impairment of coordinated bowel motility after surgery. Small bowel function returns first (within hours), then stomach (24-48 h), and colon last (48-72 h).

10. What maintenance IV fluid and electrolyte requirements per 24 hours apply to a typical adult (water, sodium, potassium)?

    Approximately water $25\text{-}30\,\text{mL/kg/day}$, sodium $\approx 1\,\text{mmol/kg/day}$, and potassium $\approx 1\,\text{mmol/kg/day}$, plus replacement of ongoing losses.

11. Define a hernia and distinguish reducible, irreducible (incarcerated), obstructed, and strangulated hernias.

    A hernia is the abnormal protrusion of a viscus (or part) through a defect in the wall of its containing cavity. Reducible = contents return to abdomen; irreducible/incarcerated = cannot be returned but viable; obstructed = bowel lumen blocked; strangulated = blood supply compromised (ischemia), a surgical emergency.

12. How do you anatomically distinguish a direct from an indirect inguinal hernia relative to the inferior epigastric vessels?

    An indirect hernia passes lateral to the inferior epigastric vessels (through the deep inguinal ring, following the cord); a direct hernia passes medial to them (through the weakened posterior wall / Hesselbach's triangle).

13. What are the boundaries of Hesselbach's (inguinal) triangle?

    Medially the lateral border of rectus abdominis, laterally the inferior epigastric vessels, and inferiorly the inguinal ligament. Direct inguinal hernias protrude through this triangle.

14. Which groin hernia lies below and lateral to the pubic tubercle, and why is it more dangerous?

    A femoral hernia lies below and lateral to the pubic tubercle (an inguinal hernia lies above and medial). It has a high risk of strangulation because of the narrow, rigid femoral ring, and is more common in women.

15. What is the most common cause of a true achalasia-related esophageal motility problem, and the classic barium finding?

    Achalasia results from degeneration of inhibitory myenteric (Auerbach) plexus neurons causing failure of lower esophageal sphincter relaxation. The classic barium swallow shows a dilated esophagus tapering to a 'bird's beak' at the gastroesophageal junction.

16. What is the diagnostic manometric criterion for achalasia?

    Esophageal manometry shows incomplete or absent relaxation of the lower esophageal sphincter (elevated integrated relaxation pressure) together with aperistalsis of the esophageal body.

17. Describe a Zenker (pharyngeal pouch) diverticulum and where it herniates.

    A pulsion false diverticulum herniating through Killian's dehiscence, the area of weakness between the thyropharyngeus and cricopharyngeus parts of the inferior pharyngeal constrictor. Presents with dysphagia, regurgitation, halitosis, and a neck lump.

18. What is the metaplastic change in Barrett esophagus and why does it matter?

    Replacement of the normal squamous epithelium of the distal esophagus by columnar (intestinal) epithelium with goblet cells, caused by chronic acid reflux. It is premalignant, predisposing to esophageal adenocarcinoma, and warrants endoscopic surveillance.

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