UPSC CMSE 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 UPSC CMSE, not a summary of it.

1. 1

   General Surgery

   6 topics

   • Wound Healing
   • Shock and Resuscitation
   • Hernias
   • Burns
   • Breast Disorders
   • Thyroid Disorders
2. 2

   Orthopedics

   6 topics

   • Fractures
   • Dislocations
   • Arthritis
   • Bone Tumors
   • Osteomyelitis
   • Spine Disorders
3. 3

   Urology

   6 topics

   • Urinary Tract Infections
   • Urolithiasis
   • Prostate Disorders
   • Bladder Disorders
   • Renal Tumors
   • Male Infertility

Surgery flashcards for UPSC CMSE

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

1. What are the three classical phases of wound healing, in order?

   1) Inflammatory (haemostasis + inflammation, day 0-3), 2) Proliferative (granulation, angiogenesis, epithelialization, day 3 to ~3 weeks), 3) Remodelling/maturation (collagen cross-linking, up to 1 year).

2. Differentiate healing by primary, secondary, and tertiary intention.

   Primary: clean wound edges apposed directly (sutured), minimal scar. Secondary: wound left open, heals by granulation, contraction and epithelialization (more scar). Tertiary (delayed primary): wound left open initially then closed after a few days once infection risk falls.

3. In wound healing, what is the difference in collagen type predominance between early granulation tissue and a mature scar?

   Early granulation tissue is rich in type III collagen; during remodelling it is replaced by type I collagen, increasing tensile strength.

4. What maximum tensile strength does a healed wound ultimately regain compared to normal tissue, and by when does it peak?

   A healed wound regains only about 70-80% of original tensile strength, peaking at around 3 months (60 days onward), never reaching 100%.

5. List key factors that impair wound healing.

   Local: infection, ischaemia, foreign body, tissue tension, radiation. Systemic: diabetes, malnutrition (protein, vitamin C, zinc deficiency), steroids/immunosuppression, smoking, advanced age, jaundice, uraemia, malignancy.

6. Define a keloid and contrast it with a hypertrophic scar.

   Keloid: excess scar that extends BEYOND the original wound margins, does not regress, common in dark skin and over sternum/earlobe. Hypertrophic scar: raised scar confined WITHIN wound boundaries that often regresses with time.

7. Define shock and name its four main physiological classes.

   Shock is inadequate tissue perfusion/oxygen delivery relative to demand. Classes: hypovolaemic, cardiogenic, obstructive, and distributive (septic, anaphylactic, neurogenic).

8. State the four classes of haemorrhagic (hypovolaemic) shock by percentage blood loss (ATLS).

   Class I: up to 15% (<750 mL); Class II: 15-30% (750-1500 mL); Class III: 30-40% (1500-2000 mL); Class IV: >40% (>2000 mL). Pulse and respiratory rate rise progressively; BP falls from Class III onward.

9. What haemodynamic profile distinguishes septic (distributive) shock from hypovolaemic/cardiogenic shock?

   Septic shock: LOW systemic vascular resistance with HIGH/normal cardiac output (warm shock). Hypovolaemic and cardiogenic shock: HIGH SVR with LOW cardiac output (cold, clammy).

10. What is the first-line resuscitation fluid and target in haemorrhagic shock, and the principle of damage-control resuscitation?

    Warmed balanced crystalloid initially, then early blood products in a balanced ratio (≈1:1:1 packed cells:plasma:platelets), permissive hypotension until haemorrhage control, and avoidance of the lethal triad (hypothermia, acidosis, coagulopathy).

11. Define a hernia and name the components of a typical hernia.

    A hernia is the protrusion of a viscus or part of it through an abnormal opening in the wall of its containing cavity. Components: sac (peritoneum), covering(s), and contents (e.g., bowel, omentum).

12. Differentiate a reducible, irreducible, obstructed, and strangulated hernia.

    Reducible: contents return to abdomen. Irreducible (incarcerated): cannot be reduced, no other complication. Obstructed: lumen of contained bowel blocked. Strangulated: blood supply to contents compromised - painful, tender, surgical emergency.

13. How do you distinguish an indirect from a direct inguinal hernia anatomically?

    Indirect: passes through the deep (internal) ring, LATERAL to inferior epigastric vessels, may descend into scrotum; controlled by pressure over deep ring. Direct: bulges through Hesselbach's triangle, MEDIAL to inferior epigastric vessels, rarely enters scrotum.

14. Why are femoral hernias more prone to strangulation, and who gets them most?

    They pass through the narrow, rigid femoral ring (bounded by the lacunar ligament medially), so strangulation risk is high. Most common in elderly multiparous women; they appear below and lateral to the pubic tubercle.

15. State the boundaries of Hesselbach's (inguinal) triangle.

    Medial: lateral border of rectus abdominis. Lateral: inferior epigastric vessels. Inferior (base): inguinal ligament.

16. How is the percentage of total body surface area (TBSA) burned estimated in adults by the Rule of Nines?

    Head & neck 9%, each upper limb 9%, anterior trunk 18%, posterior trunk 18%, each lower limb 18%, perineum 1% (palm of patient ≈ 1%).

17. State the Parkland formula for fluid resuscitation in burns and how it is administered.

    Parkland: 4 mL × body weight (kg) × %TBSA burned of Ringer's lactate in the first 24 h. Half given in the first 8 h (from time of burn), remaining half over the next 16 h. Titrate to urine output (0.5-1 mL/kg/h).

18. Differentiate superficial partial-thickness, deep partial-thickness, and full-thickness burns.

    Superficial partial: blisters, painful, moist, blanches - heals spontaneously. Deep partial: red/white, less sensation, slow healing, may need grafting. Full-thickness: dry, leathery, painless (nerves destroyed), no spontaneous healing - needs excision and grafting.

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