PGMEE TEsT sEriEs for

neet & aiims

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 37-SURGERY

gastritis
type A-AI, prox stom, ca risk, parietal cell loss, ↓acid,enzyme production

in
type B-H pylori, antrum
Menetrier ds-prox stom, thick mucosa, giant rugal fold, deep crypt, foveolar
hypertrophy, ↓enzyme,acid production, ↑mucus loss

Johnson classific c/c gastric ulcer

s.
I-a/c
II-c/c
1-lesser curvature
2-gastric ulcer+duod ulcer
3-pREpyloric
4-<2cm from GEJ
5-NSAID induced

Menetrier ds
iim
hypertrophic gastric fold
hypoproteinemia
foveolar hyperplasia

Todani classific choledocal cyst

4a
I-solitary fusiform extrahepatic
II-supraduod
III-intraduod
IVA-fusiform intra&extrahepatic
IVB-multiple extrahepatic
V-multiple intrahepatic
m

bile duct stricture

Bismuth classific
Strasberg classific

Couinaud Sx anatomy liver

hepatic v, portal v
Ai

Cantlie line(GB bed→IVC), middle hep v

rt lobe
rt hep v
ant section
rt portal v
V(inf seg)
VIII(sup seg)
post section
rt portal v
 VI(inf)
VII(sup)
lt lobe
lt hep v
med section
IV
lat section
lt portal v
II

in
III

Waleaus&Glisson, Couinaud plate liver(bld vess& bile duct surround by

sheath)(HUCA)
Hilar

s.
Umbilical-bel lt portal v
Cystic-b/n GB&liver
Arantian-lig venosum

hydatid cyst liver

Gharbi classific USG
iim
reduction of bowel seq(DIJ)
Duod→ Ileum→ Jejunum

peritoneum
largest cavity of body
organ failure-lung>kidn>heart>GIT
healing by metamorphosis-mesenchymal cell
4a
a/c appendicitis
incision
RLQ transv-Davis Rockey, Fowler Weir
RLQ oblique-McArther McBurney

more leak-PJ
m

internal hemorrhoid classific

type-Rx
I-palpable, non prolapse-diet fibre, stool softenener
II-prolapse, spontan reduction-diet fibre, stool softener, elastic ligation
III-req manual reduction-ligation, excision hemorrhoidectomy, staple
Ai

hemorrhoidectomy
IV-cant be reduced-ligation, excision hemorrhoidectomy, staple hemorrhoidectomy

anal fistula
Park classific
intersphincteric(45%)
transsphincteric(40%)
suprasphincteric(20%)
extrasphincteric(5%)
 standard
subcut
submucous
low anal
high anal
pelvirectal

Weigert Meyer law

double ureter always cross

in
bn renal cyst
Bosniak classific

angiomyolipoma

s.
<4cm asympt-w/w
<4cm sympt-angioembolisation
≥4cm partial nephrectomy

renal stone

any pH-Ca oxalate

ProteUs inf-strUvite
Mx-
<2cm-ESWL
iim
acidic pH-uric acid, cystine
alkal pH-triple PO4, CaPO4

>2cm-PCNL
hard stone(brushite> cystine> Ca oxalate monohydrate> hydroxyapatite)-PCNL
cong anomaly-PCNL
4a
morbid obesity-URS
uncorrected coagulopathy-Holmium:YAG laser
child, elderly, impaired ren fn-open Sx

ureteric calculi
Mx-
<1cm-ESWL
m

>1cm-URS

McNeal zone-prostate
peripheral
transitional(periurethral)
central
Ai

ant fibromuscular stromal

uroflowmetry
I>15ml/s-norm
II=10-15ml/s-equivocal
III<10ml/s-suggestive of obstruction

pressure study(cystometry)
voiding pressure
 I<60cmH2O-norm
II=60-80cmH2O-equivocal
III>80cmH2O-suggests obstruction

electrolyte disturbance
C—K—p
I- ↑
J- ↑
S- ↑

in
ileal conduit-hyperchloremia, hypokalemia, metab acidosis
jejunal conduit-hypochloremia, hyperkalemia, metab acidosis
stom conduit-hypochloremia, hypokalemia, metab alkalosis

neurogenic UB

s.
lesion above T10(UMN)-detrusor contraction+ sphincter spasm
lesion at T10-L2(UMN)-loss of sympath afferent& efferent
lesion at S2,3,4(LMN)-sensation+, poor contraction

urethral inj
bulbar-superf extravasation(Colles)-superf perineal pouch→ scrotum,penis,ant abd
wall iim
post-deep extravasation-perivesicular space

Goldman, Colapinto&McCallum classific

inj to memb urethra

mal:fem-microprolactinoma=20:1
4a
submucous cleft palate
bifid uvula, notch hard palate, zona pellucida

thyroid gld
goitre
diffuse
euthyroid-physiologic/AI thyroiditis
m

hyperthy-prim hyperthy(Grave ds)

multinodular
euthyroid-I2 def
hyperthy-toxic nodular
solitary
euthyroid-thyroid cyst/tm
Ai

hyperthy-toxic adenoma

thyroiditis
suba/c(deQuervain, granulomatous)-viral, selflimiting, hyper→ hypo→ euthyroid,
painful,tender goitre
Rx-NSAID,steroid
c/c(AI, Hashimoto)-perimenopausal, nontender
Riedel-progressive fibrosis, woody hard, painless,nontender
Rx-tamoxifen
 suba/c(silent, painless) lymphocytic

SNIF
Sup thy a tied Near thy gld(ELN)
Inf thy a tied Far(RLN)

branchial Cyst
2nd branchial Cleft
sq epith lined, thick turbid fluid with cholesterol crystal, lymphoid ts in wall

in
neck dissection
classical radical-remove-level I-V LN+ IJV+ SCM+ CNXI+ submandib gld+ parotid gld
tail
modif radical

s.
I-preserve-CNXI
II-preserve-CNXI, IJV
III(Bocca)-preserve-CNXI, IJV, SCM
selective
supraomohyoid-remove-level I,II,III-ca oropharynx, ca cheek, ca floor& lat tongue

pheochromocytoma synd
MEN2A,2B
NF
iim
lat-remove-level II,III,IV-ca larynx, ca cervical esoph
postlat-remove-level II-V-ca post scalp& neck

vHL
Sturge Weber
Tuberous Sclerosis
4a
hernia
Nyhus classific
1-indirect+norm deep ring
2-indirect+dilated deep ring
3-post wall defect
a-direct
m

b-pantaloon
c-femoral
4-recurrent

Gilbert classific hernia

1-indirect<1fingerbreadth
Ai

2-indirect=1fingerbreadth
3-indirect>2fingerbreadth
4-direct, deep ring norm
5-direct, punch out hole, deep ring norm
6-pantaloon
7-femoral
Mx-Bassini-open post wall, 3layer
modif Bassini-not open post wall, 3layer
Lytle-narrowing deep ring
 Tanner slide-↓tension
Stoppa-post approach
Shouldice-monolayer, Stainless Steel
Usher
Lichtenstein
Kugel

hernia type
Amyand-Appendix

in
Cloquet/pectineal-b/n pectineus&its fascia
dual/pantaloon/Romberg/saddle bag-indirect+direct ing
epigastric/fatty hernia-linea alba
femoral-fem canal
giant-sac extending to midthigh

s.
Hesselbach/ext fem-lat to fem a
incision/ventral/postoperative-weak scar
inguinal-ing canal
intraparietal/interstitial-b/n abd layer
LAugier/LAcunar-defect in LAcunar lig
iim
Littre-Meckel diverticulum
lumbar-lumbar triangle
Maydle/hernia en w-intraabd bowel
Narath/prevasc-post to fem vess
obturator-obturator canal
prevesical/funicular direct-cont-UB part+prevesic fat
Richter-part of bowel circumference
sliding/hernia en glissade-slip of post peritoneum+retroperitoneum viscus
Spigelian-Spigelian fascia(fascia fr tip of 9th costal cart→pubic tubercle)
4a
umbilical-ant abd wall midline
exomphalos MInor-umbilical cord attached to sumMIt of sac
exomphalos major-umbilical cord attach to inf aspect sac

Barrets esoph
classic≥3cm
short seg<3cm
m

cardiac metaplasia(intest metaplasia on endoscopy)

abd compartment synd

↑-IAP, HR, PCWP, CVP, peak insp flow, syst vasc resistance, intrapleural press, ICP
↓CO, central venous return, visceral bld flow, ren bld flow, GFR
Ai

CNII meningioma-arachnoid

ulcer
Bazins-erythrocyanoid
Cameron-ischem ulcer fundus stom in rolling hernia
CURliNg-bURN
CusHINg-Head INjury
Hunner/elusive-interstitial cystitis
kiss-UB
 Lipschutz(ulcus vulvae acutum)-Behcet ds
Maleny(burrowing)-Microhemophilic nonhemolyt streptoc+ aerob hemolytic streptoc
inf
Martorell-HTN, atherosclerosis
rodent-BCC
Snail track-Syphilis
trophic-bedsore

university of Wisconsin soln(GALRHA)

in
Glutathione-antioxidant
Adenosine-precursor for energy met
Lactobionic acid, Raffinose, HES-prevent cell swelling
Allopurinol-free radical scavenger

s.
EUSOL(Edinburg University SOLution)
chlorinate lime=12.5g
boric acid=12.5g
distill H2O=1l

iim
Lt med visc rotation(Mattox manoevre)(LMRC)
aorta, coeliac axis, SMA, lt ren a, iliac a
Rt med visceral rotation(Catell maneovre)
rt ren vess, IVC, iliac v

type of hge
prim-immediately postoperative
reactionary-within 24h(slip ligature/HTN)
sec-within 7-14d postoperative(inf)
4a
hgic shock
class—%blood loss—ml
I-<15-<750
II=15-30=750-1500
III=30-40=1500-2000
IV->40->2000
m

level of occlusion-claudication site

aortoiliac-both gluteal reg, thigh, calf
iliofem-thigh
fempopliteal-calf
popliteal(instep)-foot
Ai

stool-ds
pea soup-typhoid
red currant jelly-intussusception
ribbon like-anal atresia
rice water-cholera
smoky-P poisoni

bariatric Sx
 restrictive
laparoscopic adjustable gastric banding
sleeve gastrectomy
vertical band gastroplasty
malabsorptive
biliopancreatic diversion
  jejunoileal bypass
combine restrictive& malabsorptive
roux-en-Y gastric bypass

in
BPD with duodenal switch

m&myocutaneous flap(Mathes& Nahai classificat)

I-1 vasc pedicle-tensor fascia lata
II-1 vasc pedicle+minor pedicle-gracilis

s.
III-2 vasc pedicle-gluteus maximus
IV-Segm vasc pedicle-Sartorius
V-1 dominant pedicle+sec segm pedicle-latissimus dorsi

tm become palpable when cell no.=10^9

malignant
extraadrenal
multiple
iim
pheochromocytoma-rule of 10
b/l

familial
children
4a
Carney complex
large cell calcifying Sertoli cell tm
cardiac myxoma
prim pigm adrenocortic ds

VACTERL anomaly
Vertebral(L)
m

Anorectal
Cardiac(VSD>PDA>TOF)
TrachEsoph fistula
Renal
Limb(radial hypoplasia)
Ai

burn
I-epidermis-no contracture, fibrosis, scarring, heals<4-5d
II-epidermis+dermis-partial thickness
superf papillary-blister(thinwall), painful, n expose, blanch on press, new skin<2w, no
contracture, fibrosis, fr skin appendage
deep reticular-dry, hypoesthesia, n partly destroy, pinprick sensation+, new skin fr
retained keratinocyte fr hair follicle
reepithelialisation=3w
III-epidermis+dermis+subcutan-no blister, pain, blanching, leathery heal with
 contracture-Mx-skin graft
IV-charring

mild
superf burn<10%(adult), <5%(child)
deep burn<2%
moderate
sup burn=10-20%(adult), 5-10%(child)
deep burn=2-5%

in
suspected inhalation, circumferential, medical comorbidity
severe
superf>20%(adult), >10%(child)
deep burn>5%
confirm inhalation, electric burn, deep burn over face,palm,genital

s.
Wallace rule of 9
adult
head+neck=9%
2UL=18%
2LL=36%
thorax=18%
abdomen=18%
genital=1%
iim
grade I not include for adult(>12y)
child-palm=1%,each gluteal reg=2.5%
head+neck=18%
2UL=18%
2LL=27%
4a
thorax=18%
abdomen=18%
zone-I-coagulation, II-stasis, III-hyperemia
Mx
Parkland formula-4ml/kg/% burn fr time of burn, 1st ½ in 1st8h, next½ in next16h,
only crystalloid(RL)
bld has no role in 1st 24h
m

urine output
adult≥0.5ml/kg/h
child≥1ml/kg/h
tangential excision&graft<1-2d upto 20% burn
skin graft at 4°C survive upto 2w
circumferential burn-escharotomy
Ai

partial thickn burn dressing

sufamylon-mafenide acetate
Dakin-Na hypoCl

soft friable extradural hematoma with honeycomb app at PM+

inhalation burn
CO-norm=2-3%, smoker=5-7%
high risk>40%, death>50%
 laryngeal edema develop after 12h
Mx-100%O2, tracheostomy c/i

electric burn
alternate current-death d/t arrhythmia
resistance to electric current
dry skin>moist skin>bone>fat>n>m>bld
m attach to bone-charred
most fatal-entry fr lt arm, exit fr rt leg

in
myoglobinuria→ hyperkalemia→ diastolic arrest
Mx-ECG→ electrolyte correction→ high fluid→ diuretic→ debridement

TPN-complicat
hypercholesterolemia, hyperglycemia, hypertriglyceridemia, hypophosphatemia,

s.
hypokalemia, hypomagnesemia, hyperosmolar dehydration, azotemia

Monroe Kellie doctrine

intracranial Vol=Vol(bld)+Vol(brain)+Vol(CSF)
bld req(ml/100g/min)
norm>50
EEG abnorm<10
brain dead<5
iim
cerebral perfusion pressure(CPP)=MAP–ICP
CPP>70mmHg, MAP>90mmHg

transplant
heart
4a
10y survival=50%
CHF, NYHA III,IV
donor-brain dead treat with dopamine
cold ischemia time(aortic cross clamp in donor→ release aortic cross clamp in
recipient)=4h
technique-bicaval
m

kidn
living donor-life expect=20y
10y survival=77%
deceased donor-life expect=14y
10y survival=64%
abs c/i-ABO incompatibility
Ai

rel c/i-AIDS, active hepatitis

morbidity in donor after donation-FSGS, premature ren fail
earliest sign rejection-↑sr creatinine
Rx reject-methylprednisolone, anti thymocyteAb
opportunistic inf
<6mth-bact inf
1-6mth-CMV(Rx-valganciclovir)
>6mth-polyoma(BK virus)-most specif
cholemic nephrosis/jaundice related nephropathy
 renal transplnt→ obstructive jaundice→ bile tox→ ren tubular cell→ ↓GFR,↑ur bile
salt,bilirubin→ ren failure

liver
5y survival-low risk=80%, high=50%
MC indication-child-biliary atresia, adult-HCV
highest priority recipient-fulminant hep fail
donor
brain dead<60y

in
living-rt lobe, 18-60y, genetic related
ABO matching req, HLA match not req
reject-↑STB,SGPT, c/c reject-vanishing bile duct synd
recurr
no-Wilson ds, αAT def

s.
comm-AI hep, c/c HBV, HCV, fulminant HAV
auxillary orthotopic-recipient liver not remove

lung
survival rate-5y=40-60%, 10y=20-40%, max with-cystic fibrosis
iim
MC indication-COPD(BODE index=7-10)
b/l>u/l

procedure-age for elective Sx

PDA-at birth
ectopic vesicae<72h
biliary atresia<3mth
cleft lip=3-6mth
hemangioma=6mth
4a
vitellointestinal duct=6mth
cong hydrocele>6mth
hypospadias=6mth-1y
undescended testis=6mth-1y(<2y)
tongue tie=1y
cleft palate=1y
epispadias=1y
m

Hirschsprung ds=1y
phimosis=2-3y
umbilical hernia=2-3y
ASD=2-5y
COA=3-4y
inguinal hernia-any age
Ai

instrument
Allis forceps(sharp teeth)-grasp tough ts like fascia
Judd Allis-intest ts
hEAvy Allis-brEAst ts
Babcock forceps-grasp delicate ts(FT, intest, appendix, ovary, UB)
Backhaus towel clip-hold towel&drape
blade
10-15-BP handle3-small-plastic Sx
 18-24-BP handle4-large-skin
handle7-deep ts, eye, ENT Sx
blade11-arteriotomy
blade15-minor Sx(lipoma, sebaceous cyst)
blade21-23-maj Sx(laparotomy)
Doyen cross action towel clip-fix drape towel, diathermy cable, suction tube, rib
Fent sleeve-LES pressure
Gigli saw
Heath suture cutting scissor

in
iris suture scissors
Kelly hemostat(serrated)-clamp large vess
Kocher forceps(toothed)-grasp heav ts
Lister bandage scissors-cut bandage
Lister sinus forceps-I&D Hilton meth, hold gauge swab to clean abscess

s.
Maryland forceps-laparoscopic Sx
Mayo/suture scissors-cut tough struct(linea alba, rectus sheath), delicate
struct(hollow viscus)
Metzenbaum scissor-cut delicate ts
Mosquito hemostat(serrated)-clamp small vess
iim
needle holder-hold needle when suture
nontoothed forceps
Rampley swab holding forceps
Seldinger needle-arteriography
suture
absorbable
biological
pLain/7d catgut(violin-yeLLow)-sheep intest submucosa, time=7-10d, fat stitch
chROmic/21d catgut(bROwn)-catgut+chromic salt, time=15-25d, round body
4a
needle, 2-0-thickn suture, good knotting, preservative-70%isopropyl alcohol+
5%glycerine(keep soft)
synthetic
VIcryl/polyglactIN(VIolet)-glycolide+lactide, absorbed by hydrolysis, can be used in
INf, INtest anastomosis
dExon/pOLYglyColic acid(CrEamy YeLLOw)-braided=4-6mth
polydioxanone(creamy)=6mth
m

polyglyconate/maxon
monocryl/polyglycaprone
collagen
nonabsorbable
biological
mersilk(black)
Ai

black silk-cocoon silkworm larva,more ts rxn

cotton(white)
synthetic
proLEne/polyproylene(bLuE)-abd closure, hernia repair, high memory
sutupack(black)
Sx steel
nylon/ethilon/nurolon/polyamide(green)
polyester/mersilene/ethibond
polybutester
 tooth forceps-grasp ts, m, skin
single tooth(rat tooth)
multiple tooth

NAMED Sx
Bianchi-SI synd
Billroth-gastrectomy
Bishop Koop, Santulli-meconium ileus
Charles Phillips, Noble plication-SI obstruction

in
Denis Browne, Mathieu, Mustardee, Asopa Duckett, Thiersch Dupley(Barcka)-plastic
repair Hypospadias
Dohlman-Zenker Diverticulum
Frey, Beger, Berne, Hamberg, Puestow, Parring Rochelle, Duval-c/c pancreatitis
Freyer(suprapubic), Millin(transpubic), Young(perineal) prostatectomy-BPH

s.
Furlow, Hynes pharyngoplasty-cleft palat
Hadfield-duct ectasia
Hartman-volvulus+peritonitis
Heller-achalasia cardia
Heineke Mikulicz-duod obstruction
iim
Huntington ligature-aneurysm
Jones, Rech, Wobig-recur/severe entropion
Jones, Tompkin-septate uterus
Kasai-extrahepatic biliary atresia
Ladd-gut malrotation
Limberg, Karydakis flap,sBoscom-pilonidal sinus
Lord, Jaboulay-hydrocele
Marshal Marchetti(suprapubic), Edward William(retropubic)-stress incontinence
Milard rotation advancement, Teneeson, LeMusserier-cleft lip
4a
Miligan Morgan, Ferguson, Whitefield, Longo hemorrhoidectomy-hemorrhoids
Moh-BCC oral cavity
Nesbit-Peyronie ds
Nissen fundoplication(360°), Belsey Maak IV(270°), Toupet(180°), Watson(90°),
Allison, Collis gastroplasty-hiatus hernia
Notaras lat anal sphincterotomy, Lord dilatation-anal fissure
Ombredanne, Stephen Flower-undescended testes
m

Pen-high anorectal anomaly

Pouchet, Kelling Medlener, Csendes, Hill Backer, Taylor-peptic ulcer
Ramstead-pyloric stenosis
Riche suprapubic cystostomy-a/c urinary retention
sacculotomy(Fick Sx, Cody Tack Sx)-Meniere ds
Sistrunk-thyroglossal cyst/sinus
Ai

Steindler release-cavus deformity foot

Strassman metroplasty-bicornuate uterus
Sugiura devascularisation-recur variceal bld
Thiersh(child), Delorome(elderly), Altemier(remove prolapse rectum&sigm colon fr
bel→ coloanal anast), Ripstein(adult), Well, Lahaut, Orr Loygue, Frykman Goldberg-full
thickn rectal prolapse
Thompson Swiss roll, Charles excision, nodovenous shunt, Homan,
sistrunk-lymphedema
Whipple pancreatoduodenectomy, Longmire Traverso-ca head pancr
 Young, Lautenslager-atrophic rhinitis

Abbreviations
a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune
bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch,
Bx-biopsy
ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral,
conc-concentration, cong-congenital, Cx-cervix
d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis

in
E-estrogen
fem-female, fr-from
gld-gland, glu-glucose
h-hormone
idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury

s.
lig-ligament, LL-lower limb, l/t-leading to
m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor,
mtx-methotrexate, Mx-management
n-nerve, norm-normal
P-progesterone, pl-plasma, prot-protein, pt-patient
Rx-treatment
iim
SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure
tm-tumour, ts-tissue
UL-upper limb, u/l-unilateral
vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume
w-week, wt-weight
Xr-X ray
y-year
#-fracture
4a
°-degree

THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP TO PG
ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE HAS
BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.
m
Ai
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