NEET PG Surgery Syllabus

What is the inheritance and gene defect in Familial Adenomatous Polyposis (FAP), and the lifetime cancer risk?

Autosomal dominant mutation in the APC gene (chromosome 5q21); virtually 100% lifetime risk of colorectal cancer if untreated, hence prophylactic colectomy is recommended.

What are the Amsterdam II criteria used to clinically screen for Lynch syndrome (HNPCC)?

The '3-2-1' rule: 3 relatives with a Lynch-associated cancer (1 a first-degree relative of the others), spanning 2 successive generations, with 1 diagnosed before age 50, and FAP excluded.

What is Charcot's triad and Reynolds' pentad in biliary disease?

Charcot's triad (acute cholangitis): fever/chills, RUQ pain, jaundice. Reynolds' pentad adds hypotension (shock) and altered mental status, indicating suppurative cholangitis.

What is Murphy's sign and what condition does it indicate?

Inspiratory arrest during palpation of the RUQ due to pain; a positive sign indicates acute cholecystitis.

What is Courvoisier's law in the setting of obstructive jaundice?

A palpable, non-tender, enlarged gallbladder in a jaundiced patient is unlikely to be due to gallstones (which cause a fibrotic, contracted gallbladder) and suggests malignant biliary obstruction (e.g., pancreatic head cancer).

What is the strongest risk factor for gallbladder carcinoma, and which finding warrants prophylactic cholecystectomy?

Gallstones (especially large >3 cm) and chronic inflammation; a 'porcelain gallbladder' (calcified wall) and adenomatous polyps >1 cm warrant cholecystectomy due to malignancy risk.

In liver anatomy, what is the Cantlie line and its surgical significance?

An imaginary plane from the gallbladder fossa to the IVC; it divides the liver into right and left functional (Couinaud) lobes along the middle hepatic vein, defining the plane for hemihepatectomy.

What tumor marker is elevated in hepatocellular carcinoma, and what is the most common cause of HCC worldwide?

Alpha-fetoprotein (AFP). Chronic hepatitis B (and C) leading to cirrhosis is the most common cause worldwide.

What is the Child-Pugh score used for, and which five parameters does it include?

It assesses cirrhosis severity and surgical/operative risk. Parameters: bilirubin, albumin, INR (prothrombin time), ascites, and encephalopathy ('ABCDE' minus one).

Differentiate the two anatomic types of acute pancreatitis severity and name the most common causes.

Interstitial edematous (mild, self-limiting) versus necrotizing (severe). The two most common causes are gallstones and alcohol.

What are Cullen's sign and Grey Turner's sign in severe acute pancreatitis?

Cullen's sign: periumbilical bruising; Grey Turner's sign: flank bruising. Both indicate retroperitoneal hemorrhage from severe (hemorrhagic/necrotizing) pancreatitis.

What is the most common location of pancreatic ductal adenocarcinoma, and what operation is used for resectable head tumors?

The head of the pancreas (~60-70%); resectable head/periampullary tumors are treated with a Whipple procedure (pancreaticoduodenectomy).

What is the most common cause of hyperthyroidism, and the most common cause of a solitary toxic nodule?

Graves' disease (autoimmune TSH-receptor antibodies) is the most common cause of hyperthyroidism overall; a toxic adenoma is the cause of a solitary toxic (hot) nodule.

Which thyroid cancer is most common, spreads via lymphatics, and has the best prognosis; and which arises from parafollicular C cells?

Papillary carcinoma is most common, spreads lymphatically, and has the best prognosis (Orphan-Annie eye nuclei, psammoma bodies). Medullary carcinoma arises from C cells and secretes calcitonin.

During thyroidectomy, injury to which nerve causes hoarseness, and to which causes loss of high-pitched voice?

Recurrent laryngeal nerve injury causes hoarseness/vocal cord paralysis; external branch of the superior laryngeal nerve injury causes loss of voice projection/high-pitch (affects cricothyroid muscle).

What is the most common cause of primary hyperparathyroidism and its classic clinical mnemonic?

A single parathyroid adenoma (~85%); presentation: 'stones, bones, abdominal groans, and psychiatric moans' (renal stones, bone pain/osteitis, constipation/peptic ulcer, depression) with hypercalcemia.

What is the most common cause of secondary hyperparathyroidism?

Chronic kidney disease (chronic renal failure) causing hyperphosphatemia, low calcium, and reduced vitamin D activation, leading to compensatory parathyroid hyperplasia.

What triad defines a pheochromocytoma, and what is the rule of 10s?

Classic triad: episodic headache, sweating (diaphoresis), and palpitations/tachycardia with hypertension. Rule of 10s: ~10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial, 10% in children.

What is the preoperative preparation sequence for pheochromocytoma resection?

Alpha-blockade FIRST (e.g., phenoxybenzamine) for 7-14 days, then beta-blockade if needed; never beta-block first (unopposed alpha causes hypertensive crisis).

What is the most common cause of Cushing's syndrome (excluding iatrogenic) and of primary hyperaldosteronism?

Cushing's: pituitary ACTH-secreting adenoma (Cushing's disease). Primary hyperaldosteronism (Conn syndrome): aldosterone-producing adrenal adenoma.

What is fibroadenoma, and what is its typical clinical presentation in benign breast disease?

The most common benign breast tumor in young women (<30); a well-circumscribed, firm, rubbery, freely mobile ('breast mouse') painless lump that may regress after menopause.

Differentiate fibroadenoma from phyllodes tumor.

Both are fibroepithelial; fibroadenoma is small, benign, in young women. Phyllodes tumor is larger, grows rapidly, occurs in older women (40s-50s), has 'leaf-like' stromal architecture, and can be malignant, requiring wide local excision.

What is the most common histologic type of invasive breast cancer, and which type is classically bilateral/multifocal and E-cadherin negative?

Invasive ductal carcinoma (NST) is most common (~75-80%). Invasive lobular carcinoma is more often bilateral/multifocal and shows loss of E-cadherin ('Indian file' pattern).

What receptor subtypes guide breast cancer therapy, and what defines triple-negative breast cancer?

ER, PR, and HER2/neu. Triple-negative (ER-, PR-, HER2-) cancer does not respond to hormonal or trastuzumab therapy, is more aggressive, and is associated with BRCA1 mutations.

What is Virchow's triad describing the pathophysiology of venous thrombosis?

Endothelial injury, venous stasis, and hypercoagulability — the three factors predisposing to DVT/thrombus formation.

What are the '6 Ps' of acute arterial occlusion (limb ischemia)?

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia (perishing cold). Paralysis and paresthesia indicate advanced ischemia requiring urgent revascularization.

What is the gold-standard long-term vascular access for chronic hemodialysis, and why is it preferred over catheters/grafts?

An autogenous arteriovenous fistula (e.g., radiocephalic/Brescia-Cimino); preferred for lowest infection and thrombosis rates and best long-term patency compared with AV grafts or central venous catheters.

In ATLS, what does the primary survey 'ABCDE' stand for, and what is assessed first?

Airway (with C-spine protection), Breathing, Circulation (with hemorrhage control), Disability (neuro/GCS), Exposure/Environment. Airway is addressed first.

State the Glasgow Coma Scale components and the score range, and what GCS indicates severe TBI requiring intubation.

Eye (1-4), Verbal (1-5), Motor (1-6); total 3-15. A GCS of 8 or less indicates severe traumatic brain injury and the need to secure the airway ('GCS 8, intubate').

Differentiate epidural from subdural hematoma on CT and typical vessel/clinical course.

Epidural: biconvex/lens-shaped, doesn't cross sutures, middle meningeal artery tear, classic lucid interval. Subdural: crescent-shaped, crosses sutures, bridging vein tear, common in elderly/alcoholics.

In blunt abdominal trauma, which two solid organs are most commonly injured, and what is the FAST exam used for?

The spleen (most common in blunt trauma) and liver. FAST (Focused Assessment with Sonography for Trauma) detects free intraperitoneal/pericardial fluid (blood) in the hemodynamically evaluable patient.

What is the indication for immediate laparotomy after abdominal trauma regardless of imaging?

Hemodynamic instability with a positive FAST, peritonitis, evisceration, gunshot wounds traversing the peritoneum, or free air/diaphragmatic rupture — these mandate exploratory laparotomy.

What is the Salter-Harris classification used for, and which type is most common?

It classifies pediatric physeal (growth plate) fractures (Types I-V; mnemonic SALTR). Type II (fracture through physis + metaphysis) is the most common.

What is the most feared early complication of a femoral neck fracture and the most common late complication?

Early/late: avascular necrosis of the femoral head (due to disruption of the retinacular vessels/medial femoral circumflex artery) and nonunion, owing to the precarious intracapsular blood supply.

What is the difference between total joint arthroplasty (replacement) for osteoarthritis, and the most common cause of late revision in total hip replacement?

Arthroplasty replaces damaged articular surfaces with prosthetic components to relieve pain and restore function; aseptic loosening (often from polyethylene wear/osteolysis) is the most common cause of late revision.

What is the most common indication for lumbar spine surgery (discectomy), and the classic clinical sign of L5-S1 disc herniation?

A herniated/prolapsed intervertebral disc causing nerve root compression (sciatica) refractory to conservative care; L5-S1 herniation compresses the S1 root (positive straight-leg-raise, loss of ankle jerk).

What is the most common type of kidney (renal) stone, and which type is radiolucent on plain X-ray?

Calcium oxalate stones are most common (~75%); uric acid stones are radiolucent and require management with urine alkalinization.

What stone size threshold typically passes spontaneously versus requires intervention, and what is the first-line treatment for a 5 mm distal ureteric stone?

Stones less than 5 mm usually pass spontaneously; those over 7 mm often need intervention. A 5 mm distal ureteric stone is managed with medical expulsive therapy (alpha-blocker like tamsulosin) plus hydration/analgesia.

What is the most common malignant renal tumor in adults, and its classic triad?

Renal cell carcinoma (clear cell type, arising from proximal tubule). Classic but late triad: flank pain, hematuria, and a palpable abdominal mass (present in <10%).

Which paraneoplastic syndromes are associated with renal cell carcinoma?

Polycythemia (EPO), hypercalcemia (PTHrP), hypertension (renin), Stauffer syndrome (nonmetastatic hepatic dysfunction), and Cushing's (ACTH).

What is the most common cause of congenital ureteropelvic junction (UPJ) obstruction and the imaging study of choice to confirm functional obstruction?

Intrinsic stenosis/aperistaltic segment at the UPJ (or a crossing lower-pole vessel) causing hydronephrosis; a diuretic (Lasix) renogram (MAG3/DTPA) confirms functional obstruction; pyeloplasty (Anderson-Hynes) is the standard repair.

What is the most common cause of acquired ureteral strictures, and the typical first-line endourologic management?

Iatrogenic injury (e.g., ureteroscopy, pelvic/gynecologic surgery) and impacted stones/radiation; first-line management includes balloon dilation or endoureterotomy with stenting, reserving open/robotic reconstruction for refractory cases.

In neonatal surgery, what is the difference between gastroschisis and omphalocele?

Gastroschisis: full-thickness abdominal wall defect (usually right of umbilicus) with NO covering membrane and few associated anomalies. Omphalocele: central defect at the umbilicus with herniation INTO a membrane-covered sac and frequent associated anomalies (cardiac, chromosomal).

What is the classic presentation and diagnostic finding of duodenal atresia in a neonate?

Bilious vomiting within hours of birth (in ~75% the obstruction is distal to the ampulla) and a 'double bubble' sign (air in stomach and proximal duodenum) on X-ray; strongly associated with Down syndrome.

What is the most common surgical cause of vomiting in infants at 3-6 weeks, and its classic findings?

Hypertrophic pyloric stenosis: non-bilious projectile vomiting, a palpable 'olive' in the epigastrium, visible gastric peristalsis, and a hypochloremic hypokalemic metabolic alkalosis; treated by pyloromyotomy (Ramstedt).

What is the most common cause of bowel obstruction in infants (3 months-3 years) presenting with 'red-currant jelly' stools?

Intussusception (most commonly ileocolic); presents with colicky pain, a sausage-shaped abdominal mass, and red-currant jelly stool; reduced by air/contrast enema, surgery if that fails or peritonitis is present.

What is Hirschsprung disease, its pathology, and the diagnostic gold standard?

Congenital aganglionosis (absent ganglion cells in the distal colon, usually rectosigmoid) causing functional obstruction and failure to pass meconium within 48 hours; rectal suction biopsy showing absent ganglia (with increased acetylcholinesterase) is the gold standard.