Surgery Essence Pritesh Kumar Singh
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fm1Surgery Essence
Third Edition
Pritesh Kumar Singh MBBS (MAMC) MS (Surgery) FMAS FIAGES Director PGEI Ex. Senior Resident, Lady Hardinge Medical College and Associated Sucheta Kriplani, Kalawati Saran and RML Hospital, New Delhi
fm2
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Surgery Essence
Second Edition: 2014
Third Edition: 2015
9789351528883
Printed at
fm3Dedicated to
My Parents and Uncle, Dr CP Singh
fm5Editors
ENDOCRINE SURGERY
  • Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
  • Dr Subham Jain (MCh, Surgical Oncology, TATA)
  • Dr Subham Garg (MCh, Surgical Oncology, TATA)
HEPATOBILIARY PANCREATIC SURGERY
  • Dr Swati Agarwal (DNB, Surgical Oncology)
  • Dr Vaibhav Varshney (MCh, GI Surgery, GB Pant Hospital)
  • Dr Harsh Shah (MCh, GI Surgery, GB Pant Hospital)
  • Dr Amit Jain (MCh, GI Surgery, GB Pant Hospital)
GASTROINTESTINAL SURGERY
  • Dr Vaibhav Varshney (MCh, GI Surgery, GB Pant Hospital)
  • Dr Swati Agarwal (DNB, Surgical Oncology)
  • Dr Harsh Shah (MCh, GI Surgery, GB Pant Hospital)
  • Dr Amit Jain (MCh, GI Surgery, GB Pant Hospital)
UROLOGY
  • Dr Gaurav Kochar (MCh, Urology)
  • Dr Suhani (Assistant Professor, Surgery, AIIMS)
  • Dr Manoj Kumar Das (MCh, Urology)
  • Dr Animesh Singh (MCh, Urology, AIIMS)
CARDIOTHORACIC VASCULAR SURGERY
  • Dr Tarun Raina (MCh, CTVS, GB Pant Hospital)
  • Dr Vivek Wadhva (MCh, CTVS, PGI Chandigarh)
PLASTIC SURGERY
  • Dr Ritesh Anand (MCh, Plastic Surgery)
  • Dr Alok Tiwari (MCh, Plastic Surgery)
NEUROSURGERY
  • Dr Amit Kumar Singh (MCh, Neurosurgery, RML Hospital)
  • Dr Shivender Sobti (MCh, Neurosurgery, RML Hospital)
  • Dr Ishu Bishnoi (MCh, Neurosurgery, GB Pant Hospital)
  • Dr Ugan Singh (MCh, Neurosurgery)
HEAD AND NECK
  • Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
  • Dr Subham Jain (MCh, Surgical Oncology, TATA)
  • Dr Subham Garg (MCh, Surgical Oncology, TATA)
SURGICAL ONCOLOGY
  • Dr Ashish Jakhetiya (MCh, Surgical Oncology, AIIMS)
  • Dr Subham Jain (MCh, Surgical Oncology, TATA)
  • Dr Subham Garg (MCh, Surgical Oncology, TATA)
GENERAL SURGERY
  • Dr Niket Harsh (MS, Surgery)
  • Dr Mohit Garg (MS, Surgery)
fm7Preface to the Third Edition
I thought writing the preface for the third time would be an easier job but it is actually a lot tougher because now you already know me very well. This brings many responsibilities with it, the most important of which is to keep the students satisfied.
I can proudly say that all my students have contributed a lot to get me to this place, where I am today. They have helped me in becoming a better teacher, a better author and most importantly a better human being. I take this opportunity to thank all of you. The happiness you all give me keeps me telling always to work harder to bring a positive change in the life of my students. This will be reflected in the pages of this book. I always strive to provide a winning edge to my students.
Higher education has become necessary, as graduation alone is found inadequate in this highly competitive and dynamic world. Trends in the way the questions are being asked are changing continuously. I am pleased to present this edition of Surgery Essence replete with new trends in the field of surgery. The recent questions and their concepts have been highlighted and have been written in a way that will help the students to remember and reproduce them in the examination hall. The information provided is cogent but concise to save the precious time, as we all know the clock is ticking. Time is one thing that can never be recovered once gone. Be careful!
I am passionate about excellence. Excellence in the field of education and in my efforts to groom my students to make them confident enough, that they lose the fear of failure. In order to succeed, your desire for success should be greater than your fear of failure.
PG entrance examination has made the medical world very competitive and has made it imperative for students to acquire all the skills and competencies to deliver results. My aim as an author is to provide students with a learning experience which when amalgamated with perseverance and commitment helps them in achieving goals.
I still am not sure about one thing that who is more happy when a student achieves something, the student or the teacher, but I am very sure that the teacher is more satisfied when he sees his students achieving what they deserve and desire. I am working day and night to get that satisfaction and you have to work equally hard so that you do not let me down.
I always tell my students to dream big but not while sleeping. When you dream of moon, you will at least fall amongst stars. But these dreams should always be accompanied with intelligence and hard work. To guide you work intelligently this book and the author, both are there with you throughout the year. But the hard work is totally in your hands. Accept responsibility for your life. Know it is you who will get you where you want to go, no one else.
I believe that all my students should know the importance of challenges. Challenges are what make life interesting and overcoming them is what makes life meaningful. For the time being the only challenge that you should be facing is to secure a good rank in the entrance exam. One of the most important keys to success is having the discipline to do what you know you should do, even when you do not feel like doing it. Nobody ever wrote down a plan to be broke, lazy or stupid. These things happen when you do not have a plan.
I should now conclude with my prayers and wishes for all of you. Hope you all reach your dreams. All the best...
PRITESH KUMAR SINGH
/drpriteshsingh
/drpriteshsingh
fm9Preface to the Second Edition
Today is the world of specialization and for students of medical profession, obtaining specialization in one field is of utmost significance. From my experience till now, I have come to a conclusion that there is a dearth of good books on postgraduation entrance exam in surgery. Thus, in the form of this book I have made an attempt to make a meaningful contribution for the same. I had started working on this project soon after I joined my postgraduation course and after four years of regular hard work which includes the period of preparation for my super specialization, I could bring this book. The writing of this book has also helped me in understanding the subject in a better way and I feel that I have grown better as a surgeon while writing this book.
The pattern of questions in postgraduation entrance examination has changed after introduction of NEET but when one is thorough with the subject it is a lot easier to secure a good rank in the exam. For that matter, I have incorporated explanations with every question to broaden the scope of the question. The explanations have been written in a cogent manner and without any ambiguity. The sources have been mentioned in the references so that in case of a doubt one can always go back to the textbooks. The explanations have been taken from standard textbooks available for super specialty and recent journal review articles so that one can get the best preparation without wastage of precious time of going through all those books. This has also helped me to prepare better for the controversial questions which always bring anxiety in the minds of the students.
For the best results, along with hard work, one has to strike a proper balance between the way of attempting questions, which should be strategy and time management. Time management is required not just during the examination but also during the preparation of that exam. That is why they say that one who fails to plan is planning to fail. I have tried my best to provide thorough information about a particular topic which is required for the exams coupled with effective utilization of the available time.
Most of us are generally busy in marking the facts which are important in the books without realizing that the effort would go in drain if we do not get the time to revise the same. So the practice of taking only a single reading from any book should be avoided as the net output required to be produced during the exams is not fulfilled. In this book, such key points and facts have already been highlighted; tables and line diagrams have been provided to help you revise the subject quickly before the exams.
Although every effort has been made to minimize the scope of error but still some mistakes might be there which should be brought to the notice of the author through e-mail address or in writing.
I would like to express my immense gratitude to all my colleagues, friends, teachers and family because this book is the result of encouragement, appreciation and guidance from all of them.
Wishing you all the best and looking forward for your feedback and suggestions…
PRITESH KUMAR SINGH
fm11Acknowledgments
I would like to express my greatest gratitude to the people who have helped and supported me throughout my project.
I wish to thank my parents for their undivided support and interest, who inspired me and encouraged me to go my own way, without whom I would be unable to complete my project.
I want to thank active members of PGEI family for their encouragement, support and feedback especially Mr Ganesh, Mrs Janaki, Dr Suyog Sahu, Mr Niraj Salunke, Dr Rituparna Majumdar, Dr Debdatta Majumdar, Mr Raja Rao and Dr Sushanta Bhanja.
I feel pleasure in conveying my sincere thanks to my fiancée Dr Ushika Singh (MD, Anesthesia) for helping me throughout this project and giving her valuable advices and feedbacks.
I express my sincere thanks to my friends Dr Niket Harsh (MS, Surgery, MAMC) and Dr Saurabh Rai (MS, Orthopedics). They provided me the explanations of difficult and controversial questions.
I am grateful to Dr MP Arora for the continuous support for the project, from initial advice and contacts in the early stages of conceptual inception and through ongoing advice and encouragement to this day.
I sincerely thank my uncle Dr SD Maurya (President SELSI and Ex. Professor of Surgery, SNMC, Agra) for his valuable advice and knowledge regarding the surgery subject and surgical skills, which helped me a lot in preparation of certain topics of surgery given in this book.
I wish to express my sincere thanks to Dr OP Pathania and Dr S Thomas.
I wish to express my sincere thanks to Dr Manoj Andley, Professor of surgery, LHMC, New Delhi for helping me throughout this project. His caring and fatherly attitude for the unit as well as towards his residents needs a mention. His excellent way of teaching and presentation helped me a lot in making various explanations in the book. His hard working and caring attitude towards patients is source of inspiration for me and surgery residents.
I am very thankful to Dr Ashok Kumar, Professor of surgery, LHMC, New Delhi for his valuable and indispensable help. His unique ideas regarding presentation of explanations helped me a lot in this project. It is with the help of his valuable suggestions, guidance and encouragement, that I was able to complete this project.
I am very thankful to Dr SK Tudu, Professor of Surgery, Lady Hardinge Medical College for the valuable help. He was always there to show us the right track when we needed his help. It is with the help of his valuable suggestions, guidance and encouragement, that I was able to complete this project.
I wish to express my sincere thanks to Dr Lalit Aggarwal, Dr Gyan Saurabh, Dr Sudipta Saha, Dr P Rahul, Assistant Professor of Surgery, Lady Hardinge Medical College for guiding me to complete general surgery topics.
I wish to express my sincere thanks to Dr Pawan Kumar, Dr Priya Hazrah, Dr Nikhil Talwar, Dr Ezaz Siddiqui, Dr Ashish Arsia, Dr Sadan Ali, Dr Jitender and Dr Kusum Meena, Assistant Professors of Surgery, Lady Hardinge Medical College for their indispensable contribution.
I would like to thank Dr UC Garga, Professor of Radiology, Dr RML Hospital, New Delhi, for his special guidance for radiology and valuable advices for improvement of the book and boosting my morale to bring this project.
I express my extreme gratitude for immense inspiration from my family members specially:
  • Dr Avinash Kumar Singh (Urologist)
  • Dr Charu Singh (Dermatologist)
  • Mr Abhay Kumar Singh (MBA, IMT, Ghaziabad)
  • Mrs Deepasha Singh (MBA, IMT, Ghaziabad)
  • Mr Ritesh Kumar Singh (B Tech, MBA, Symbiosis, Pune)
  • Ms Pratibha Singh (M Tech, Computer Science)
  • Ms Monika Singh (B Tech, Computer Science)
  • Ms Khushboo Singh (B Tech, Computer Science)
  • Mr Rohit Kumar Singh (B Tech, Computer Science)
  • Dr Anita Singh (MD Pediatrics, KGMC, Lucknow)
  • Dr Kundan Kumar Patel (MBBS, GSVM, Kanpur)
  • Dr Akanksha Singh (DGO, KGMC)
  • Dr Jigyasa Singh (MS, Gynae IMS, BHU)
  • Mr Abhishek Kumar Singh (B Tech, IIT Kharagpur)
  • Dr Ambuj Kumar Singh (MBBS, Era Medical College, Lucknow)
I would like to specially thank my friends for their invaluable help and advice from time to time specially:
  • Dr Niket Harsh
  • Dr Suarabh Rai
  • Dr Kumar Saurabh
  • Dr Gyan Ranjan Nayak (MS, ENT)
I feel pleasure in conveying my sincere thanks to my friends and colleagues specially:
  • Dr Kirti Patel (MS, Gynae)
  • Dr Nakshi Sinha (MD, Biochemistry)
  • fm12Dr Shipra Goel (MD, Microbiology)
  • Dr Mayank Agarwal (MS, Surgery)
  • Dr Shweta Mittal (MS, ENT)
A special thank of mine goes to Dr Parul Gautam, (MD, Pathology, MAMC), who helped me in completing the project and exchanged her interesting ideas, thoughts which made this project easy and accurate. Her help for topics related to tumor and pathology is indispensable.
I am equally grateful to my friend Dr Sushant Bhanja (MD, Pediatrics), who gave me moral support and guided me in different matters regarding the topics related to Pediatric surgery. He has been very kind and patient, whilst suggesting me the outlines of this project and correcting my doubts.
I would be failing in my duty if I do not express my thanks to all my friends who have really inspired me to write this book specially:
  • Dr Vivek Kumar (MD, Medicine)
  • Dr Neha Chaudhary (MD, Pediatrics)
  • Dr Harwinder (MS, Orthopedics)
  • Dr Nitasha (MS, Ophthalmology)
  • Dr Ugan Singh (Mch, Neurosurgery)
  • Dr Pragati Meena (MS, Gynae, SMS, Jaipur)
  • Dr Bhamini Agal (MS, Gynae, SMS, Jaipur)
  • Dr Aniket Malhotra (MD, Pediatrics)
  • Dr Anant Pachisia (MD, Anesthesia)
  • Dr Anant Shukla (MD, Anesthesia)
I would like to express my sincere thanks to my colleagues at Dr RML Hospital, especially Dr Amit Kumar Singh (MCh, Neurosurgery), Dr Shivender Sobti (MCh, Neurosurgery), Dr Humam (SR, Neurosurgery), Dr Wazid (DNB, Neurosurgery), Dr Uzair (DNB, Neurosurgery), Dr Azaz (DNB, Neurosurgery) and Dr Neeraj (DNB, Neurosurgery).
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, Dr Sushma Kataria, Dr Gyan Ranjan, Dr Kamal Yadav, Dr Priyank Yadav, Dr Vineet, Dr Munish, Dr Nivedita, Dr Tarun Raina, Dr Sumit Saini and Dr Abhinav Veerwal.
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, Dr Meenakshi, Dr Ankur, Dr Prashant, Dr Rigved, Dr Munish Raj, Dr Diwakar Pandey, Dr Vikram Deswal, Dr Gunjan Desai, Dr Vikas, Dr Nikunj Jain, Dr Hari Singh, Dr Vimlesh, Dr Mannu, Dr Anshul, Dr Vikas and Dr Abhijeet Jha, Dr Mayank Aggarwal, Dr Vipul Dogra, Dr Abhishek, Dr Kunjan, Dr Sumit, Dr Kartikey, Dr Rao Bhupender.
I would like to express my sincere thanks to my colleagues at Lady Hardinge Medical College and Associated Dr RML Hospital, for their valuable advice, specially:
  • Dr Ravindra Gupta (Ex. SR, RML Hospital)
  • Dr Prasad Bhukebag (SR, RML Hospital)
  • Dr Ritesh Pathak (SR, RML Hospital)
  • Dr Anil Gulwani (Mch, Urology)
  • Dr Nitin Sardana (Ex-SR, LHMC)
  • Dr Arvinda PS (SR, LHMC)
  • Dr Rahul Rai (Ex-SR, LHMC)
  • Dr Yogender (SR, LHMC)
  • Dr Anand Yadav (Ex-SR, LHMC)
  • Dr Shiv Navariya (SR, LHMC)
  • Dr Nihar (Mch-Hepatobiliary surgery SR, LHMC)
  • Dr Zuber Khan (FNB, Minimal Invasive Surgery, LHMC)
I would like to express my sincere thanks to my colleagues at Maulana Azad Medical College and Associated LNJP Hospital for their valuable advice, specially:
  • Dr Mohit Garg (MS, Surgery)
  • Dr Kamal Kishore Gautam (MS, Surgery)
  • Dr Anurag Mishra (MS, Surgery)
  • Dr Ashish Airen (MS, Surgery)
I would also like to thank my assistant, Rajesh Jha, who often helped me at critical junctures during the completion of this project.
I would also like to thank Mr Varish Sharma and Mr Anurag Sharma of MAMC Bookshop for their encouragement for writing this book.
I would like to thank Dr Ashish Jakhetiya and Dr Inderjeet Yadav, who helped me a lot in gathering different information, collecting data and guiding me from time to time in completing this project. Despite their busy schedules, they gave me different ideas to help make this project unique.
I convey my sincere thanks to Dr Yatin Talwar for his constant encouragement and feedback regarding improvement of quality of explanations.
I convey my sincere thanks to my PGEI Delhi staff members Mr Isac Thaoveinii (Manager), Mr Mohit Singh (Assistant Manager), and Mr Rajesh Jha (Class Coordinator).
Last but not the least I want to thank all my students who appreciated me for my work and motivated me and finally to God who made all the things possible.
I feel pleasure in conveying my sincere thanks to Ms Chetna Malhotra Vohra (Associate Director), Ms Saima Rashid (Project Manager) for helping me throughout this project and giving their valuable advices and feedback.
I convey my sincere thanks to the team of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for their efforts and suggestions in timely publication of the book.
fm15Annexures
Annexure 1
 
NAMED CLASSIFICATION FOR TUMORS
Important Tumor Classification
Chang stagingQ
MedulloblastomaQ
Masoaka stagingQ
ThymomaQ
Shimda indexQ
NeuroblastomaQ
Reiss and Ellsworth classification
Esson prognostic indexQ
RetinoblastomaQ
Bloom-Richardson gradingQ
CA breastQ
Naguchi classificationQ
Adenocarcinoma lungQ
Sullivan modification of Macfalene systemQ
Adrenocortical carcinomaQ
Gleason
CA prostateQ
Nevine staging
CA GBQ
Duke staging
Colorectal carcinomaQ
Robson staging
RCCQ
Jackson
CA penisQ
Annexure 2
 
GENES AND CHROMOSOMES
Syndrome
Genes
Locations
Breast/ovarian syndrome
BRCA1
17
BRCA2Q
13Q
Cowden's disease
PTENQ
10Q
FAP
APCQ
5Q
HNPCC
hMLH1Q
3Q
hMSH2Q
2Q
hMSH6
2Q
hPMS1
2Q
hPMS2
7Q
Hereditary papillary RCC
METQ
7Qfm16
Li-Fraumeni
p53Q
17Q
hCHK2
22
MEN-1
MEN1Q
11Q
MEN-2
RETQ
10Q
NF-1
NF1Q
17Q
NF-2
NF2Q
22Q
Peutz-Jeghers syndrome
STK11Q
19Q
Retinoblastoma
RBQ
13Q
Tuberous sclerosis
TSC1Q
9Q
TSC2Q
16Q
VHL syndrome
VHLQ
3Q
Wilms’ tumor
WTQ
11Q
fm17Annexure 3
 
NAMED TRIADS
Important Triads
Triad
Seen in
Components
Virchow's TriadQ
Thrombosis
Hypercoagulability + Stasis + Endothelial injuryQ
Galezia's TriadQ
Dupuytren's contracture + Retroperitoneal fibrosis + Peyronie's disease of penisQ
Cushing's TriadQ
Intracranial hypertension
BP + Bradycardia + respiratory rate
Hutchison's TriadQ
Congenital syphilis
Hutchison's teeth (notched upper incisors) + Interstitial keratitis + Nerve deafnessQ
Trotter's TriadQ
Nasopharyngeal Carcinoma
Conductive hearing loss + Immobility of homolateral soft palate + Trigeminal neuralgiaQ
Important Triads
Triad
Seen in
Components
Saints Triad
Hiatus hernia + Gallstones+ Colonic diverticulosisQ
Dieulafoy's TriadQ
Acute appendicitis
Hypersensitiveness of skin + Reflex muscular contraction + tenderness at Mac Burney's pointQ
Quinck's TriadQ
Hemobilia
GI hemorrhage + biliary colic + jaundiceQ
Borchardt's TriadQ
Gastric Volvulus
Epigastric pain + Inability to vomit + Inability to pass a NG tubeQ
Tillaux's TriadQ
Mesenteric cyst
Soft fluctuant swelling in umbilical region + Freely mobile perpendicular to mesentery + Zone of resonance all aroundQ
Mackler's TriadQ
Boerhaave's syndrome
Thoracic pain + vomiting + cervical subcutaneous emphysemaQ
Rigler's TriadQ
Gall stone ileus
Small bowel obstruction + Pneumobilia + Ectopic gallstoneQ
Whipple's TriadQ
Insulinoma
Symptoms of hypoglycemia + S. glucose <45 mg/dl + Symptomatic relief on glucose ingestionQ
Annexure 4
 
LYMPH NODES
Most Common Lymph Nodes Involved
CA Penis
Inguinal LNQ
CA Testis
On right: Inter-aortocavalQ LN
On left: ParaaorticQ LN
CA Bladder
ObturatorQ LN
CA Prostate
ObturatorQ LN
Important Lymph Nodes
Rotter's nodesQ
  • Interpectoral nodes (CA breast)Q
Rouvier nodesQ
  • Retropharyngeal nodes (CA Nasopharynx)Q
Delphian nodesQ
  • Pre-cricoid/Pre-tracheal/Pre-laryngeal lymph nodesQ
Irish nodesQ
  • Nodes in left axilla (CA stomach)Q
Sister Mary Joseph nodesQ
  • Periumbilical metastatic cutaneous nodules
Virchow nodesQ
  • Left supraclavicular nodeQ
Cloquet nodeQ
  • Femoral canal nodeQ
LN of LundQ
  • Cystic lymph nodeQ
Krouse Lymph node
  • Jugular fossa lymph nodeQ
fm18Annexure 5
 
METASTASIS
Carcinoma Thyroid
Type
Mode of spread
Papillary carcinoma
LymphaticQ spread
Follicular carcinoma
HematogenousQ spread
Medullary carcinoma
Both lymphatic and hematogenousQ spread
Anaplastic carcinoma
Direct invasionQ
Carcinoma Thyroid
Type
MC site of Metastasis
Papillary carcinoma
LungsQ
Follicular carcinoma
BonesQ
Medullary carcinoma
LiverQ
Anaplastic carcinoma
LungsQ
Pulsating Secondaries
  1. Follicular carcinoma thyroidQ
  2. RCCQ
Bone Metastasis in Carcinoma Thyroid
Follicular carcinoma
Osteolytic metastasis (Pulsating secondaries in flat bones) Q
Medullary carcinoma
Osteoblastic metastasisQ
Metastatic Tumors
Metastatic Tumors of Thyroid
  • Rare, most cases are found in autopsy
  • MC site of primary: CA BreastQ > CA Lung
  • If thyroid metastases is detected pre-mortem, MC site of primary: RCCQ > CA Breast > CA Lung
Metastatic Tumors to lung, MC primary: CA breastQ
Metastatic Tumors to Pancreas
  • MC site of primary: RCCQ > Malignant melanoma
  • On autopsy, MC site of primary: CA lungQ
Metastatic Tumors Adrenal, MC site of primary: CA LungQ
Metastatic Tumors to Small Bowel
  • Metastatic tumors involving small bowel are more common than primary tumors
  • MC site of primary: Other intra-abdominal organs
  • MD extra-abdominal source: Melanoma> CA Breast> CA Lung
Metastatic Tumors
Metastatic Tumors to Skin
  • MC site of primary in males: CA LungQ
  • MC site of primary in females: CA BreastQ
  • Scalp is MC site for cutaneous metastatic diseaseQ
Metastatic Tumors to Liver
  • MC site of primary: CA LungQ> CA Colon> CA Pancreas> CA Breast> CA Stomach
fm19
Metastatic Tumors to CNS
  • MC site of primary for brain metastases: CA LungQ > CA Breast
  • MC site of primary for leptomenigeal metastases: CA BreastQ
Metastatic Tumors to esophagus, MC primary: CA lungQ
Metastatic Tumors to spleen
  • MC site of primary: CA lungQ >CA breast >Melanoma
Metastatic Tumors to Heart
  • MC primary in males: CA lungQ
  • MC primary in females: CA breastQ
Metastatic Tumors to Testis
  • MC site of primary: CA prostateQ > CA lung >GI malignacies >melanoma >kidney
Metastatic Tumors to penis, MC site of primary: CA bladderQ
Annexure 6
 
MOST COMMON SYMPTOMS AND CHEMOTHERAPY
GI Malignancy
Chemotherapy
  • CA Esophagus
ECF (E pirubicin + C isplatin + 5- F U)Q
  • CA Stomach
ECF (E pirubicin + C isplatin + 5- F U)Q
  • CA Pancreas
GemcitabineQ
  • NET of pancreas
Streptozocin + 5-FUQ
  • Cholangiocarcinoma
Gemcitabine + CisplatinQ
  • CA GB
Gemcitabine + CisplatinQ
  • Small intestine adenocarcinoma
5-FUQ
  • Colorectal carcinoma
FOLFOX-IV (5-FU + Leucovorin + Oxaliplatin)Q
  • CA anal canal
Nigro Regimen: Chemoradiation (5-FU + Mitomycin C + Radiation)Q
Most Common Symptom
CA Esophagus
  • Dysphagia >weight lossQ
CA stomach
  • Abdominal pain >weight lossQ
Periampullary carcinoma ( including CA head of pancreas)
  • JaundiceQ
HCC
  • Abdominal pain >weight lossQ
Cholangiocarcinoma
  • Painless progressive jaundiceQ
CA Gallbladder
  • Biliary colicQ
CA small bowel
  • Abdominal painQ
CA colon
  • Abdominal painQ
CA rectum
  • Bleeding PRQ
CA anal canal
  • Bleeding PRQ
fm20Annexure 7
 
MOST COMMON SITES
Important Most Common Sites
  • Gastric ulcerQ
Lesser curvature (near incisura angularis)
  • Peptic ulcerQ
  • Gastric outlet obstructionQ
1st part of duodenum
  • Small bowelQ adenocarcinoma
  • AtresiaQ
Duodenum
  • Polyps in PJSQ
  • Pneumatosis intestinalisQ
Jejunum
  • Crohn's diseaseQ
  • Fistula, perforation and carcinoma in Crohn's diseaseQ
  • Typhoid ulcerQ
  • Tubercular ulcerQ
  • Small intestinal lymphomaQ
  • Gallstone ileusQ
Terminal Ileum
  • Amebic colitisQ
  • Bleeding in angiodysplasiaQ
  • Bleeding in colonic diverticulaQ
Cecum and ascending colon
  • Ischemic colitisQ
Splenic flexure
  • Colonic diverticulaQ
  • Stricture after ischemic colitisQ
  • VolvulusQ
Sigmoid
  • Ulcerative colitisQ
  • Colorectal cancerQ
  • Hirschprung's diseaseQ
Rectum
Annexure 8
 
TREATMENT OF CHOICE
Condition
Treatment of Choice
Duodenal Atresia
DuodenoduodenostomtyQ
Annular pancreas
DuodenoduodenostomtyQ
Superior mesenteric artery syndrome
DuodenojejunostomyQ
Enucleation is treatment of choice in
  1. Hemangioma liverQ
  2. Leiomyoma esophagusQ
  3. Chylolypmhatic cystQ
  4. Insulinoma involving head of pancreasQ
fm21Annexure 9
 
CHARACTERISTIC RADIOLOGICAL APPEARANCES
Radiological Features
Seen in
  • Apple core lesion on barium enema
Carcinoma colonQ
  • Claw appearance on barium enema
IntussusceptionQ
  • Saw tooth appearance
Colonic diverticula
  • Bird beak appearance
AchalasiaQ
Volvulus
  • Cork screw appearance
  • Rosary bead appearance
  • Pseudodiverticula appearance
Diffuse esophageal spasmQ
  • String sign of Kantor
Crohn's diseaseQ
Tuberculosis
  • Thumb print sign
Ischemic colitisQ
  • Squeeze sign, Cushion sign, Tenting sign, naked fat sign
Colonic lipomaQ
  • Rat tail appearance
AchalasiaQ
Characteristic Appearances
ADPKD
  • Spider leg or Bell deformityQ
  • Bubble or Swiss cheese appearance on IVPQ
Infantile PKD
  • Sunburst pattern on IVPQ
Medullary Sponge Kidney
  • Bristles on brush appearanceQ
  • Bouquet of flower appearance on IVPQ
Multicystic Dysplastic Kidney
  • Bunch of grapes appearanceQ
Renal Artery Aneurysm
  • Ring like calcificationQ
Ectopic Ureteric Orifice
  • Drooping lily sign on IVPQ
Retrocaval Ureter
  • Fish hook or Reverse ‘J’ deformity on IVPQ
Retroperitoneal Fibrosis
  • Medial pulling of ureter or pipestem ureterQ
    (Pipestem ureter is also seen in TB)
CA Renal Pelvis
  • Goblet sign or stipple sign on RGPQ
Radiological feature
Disease
  • Rim/ crescent signQ
  • Soap bubble appearanceQ
Hydronephrosis
  • Spider leg appearanceQ
Polycystic Kidney
  • Flower vase appearance of ureterQ
Horse shoe Kidney
  • Golf hole ureterQ
TB bladder
  • Drooping lily signQ
Ectopic ureter
  • Cobra head or Adder head appearanceQ
  • Spring onion appearanceQ
Ureterocele
  • Egg in cup appearanceQ
Analgesic nephropathy causing papillary necrosis
  • Thimble bladderQ
Tubercular chronic cystitis
  • Sandy patchesQ
Schistosomiasis of bladder
  • Chalice/ Bergman signQ
Ureteric dilatation distal to neoplasmfm22
  • Fish hook bladderQ
BPH
  • B/L spider leg appearanceQ
  • Swiss- cheese nephrogramQ
  • Sun burst nephrogramQ
Polycystic kidney
Radiological Appearance
Acute Pancreatitis
Chronic Pancreatitis
CA Pancreas
  • Renal halo signQ
  • Gasless abdomenQ
  • Ground glass appearanceQ
  • Colon cut off signQ
  • Sentinel loopQ
  • Chain of lakes appearanceQ
  • String of pearl appearanceQ
  • Beaded appearanceQ
  • Numerous irregular calcificationsQ are pathognomonic (on X-ray)
  • Double contour of medial border of duodenal C loop
  • Double duct signQ
  • Dilated/widening of duodenal C loopQ
  • Mucosal irregularityQ
  • Scrambled egg appearance
  • Inverted/reverse 3 sign of FrostbergQ
  • Rose thorning of medial wall of 2nd part of duodenumQ
Annexure 10
 
ABDOMINAL EXAMINATION SIGNS
Abdominal Examination Signs
Sign
Description
Diagnosis
Aaron sign
Pain or pressure in epigastrium or anterior chest with persistent firm pressure applied to McBurney's pointQ
Acute appendicitisQ
Bassler sign
Sharp pain created by compressing appendix between abdominal wall and iliacus
Chronic appendicitis
Blumberg's sign
Transient abdominal wall rebound tendernessQ
Peritoneal inflammation
Carnett's sign
Loss of abdominal tenderness when abdominal wall muscles are contracted
Intra-abdominal source of abdominal pain
Chandelier sign
Extreme lower abdominal and pelvic pain with movement of cervix
Pelvic inflammatory disease
Claybrook sign
Accentuation of breath and cardiac sounds through abdominal wall
Ruptured abdominal viscus
Courvoisier's sign
Palpable gallbladder in presence of painless jaundiceQ
Periampullary tumorQ
Cruveilhier sign
Varicose veins at umbilicus (caput medusae)Q
Portal hypertensionQ
Danforth sign
Shoulder pain on inspiration
Hemoperitoneum
Fothergill's sign
Abdominal wall mass that does not cross midline and remains palpable when rectus contracted
Rectus muscle hematomas
Mannkopf's sign
Increased pulse when painful abdomen palpated
Absent if malingering
Ransohoff sign
Yellow discoloration of umbilical region
Ruptured CBDQ
Ten Horn sign
Pain caused by gentle traction of right testicleQ
Acute appendicitisQ
fm23Annexure 11
 
FAMILIAL CANCER SYNDROMES
Familial Cancer Syndromes
Syndrome
Genes
Locations
Cancer Sites and Associated Traits
Breast/ovarian syndrome
BRCA1
17 q21Q
Cancer of breast, ovary, colon, prostateQ
BRCA2
13 q12.3Q
Cancer of breast, ovary, colon, prostate, gallbladder and biliary tree, pancreas, stomach; melanomaQ
Cowden's disease
PTEN
10 q23.3Q
Cancer of breast, endometrium, thyroidQ
FAP
APC
5q21Q
Cancer of breast, endometrium, thyroid
Familial melanoma
p16
9p21
Melanoma, pancreatic cancer, dysplastic nevi, atypical moles
CDK4
12q14
Hereditary diffuse gastric cancer
CDH1
16q22
Gastric cancer
HNPCC
hMLH1Q
3 p21Q
Colorectal cancer, endometrial cancer, transitional cell carcinoma of ureter and renal pelvis, carcinomas of the stomach, small bowel, pancreas, ovaryQ
hMSH2Q
2 p22-21
hMSH6
2 p16Q
hPMS1
2 q31.1
hPMS2
7 p22.2Q
Hereditary papillary RCC
METQ
7 q31Q
Renal cell cancer
Hereditary paraganglioma and pheochromocytoma
SDHB
1p36.1-p35
Paraganglioma, pheochromocytoma
SDHC
1q21
SDHD
11q23
Juvenile polyposis coli
BMPRIA
10q21-q22
Juvenile polyps of the gastrointestinal tract, gastrointestinal malignancies
SMAD4/DPC4
18q21.1
Li-Fraumeni
p53
17 p13Q
Breast cancer, soft tissue sarcoma, osteosarcoma, brain tumors, adrenocortical carcinoma, Wilms’ tumor, phyllodes tumor (breast), pancreatic cancer, leukemia, neuroblastomaQ
hCHK2
22q12.1
MEN-1
MENINQ
11 q13Q
Pancreatic islet cell tumors, parathyroid hyperplasia, pituitary adenomasQ
MEN-2
RETQ
10 q11.2
Medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasiaQ
MYH-associated adenomatous polyposis
MYH
1p34.3-p32.1
Cancer of the colon, rectum, breast, stomach
Neurofibromatosis-1
NF1Q
17 q11Q
Neurofibromas, neurofibrosarcoma, acute myelogenous leukemia, brain tumorsQ
Neurofibromatosis -2
NF2Q
22 q12Q
Acoustic neuromas, meningiomas, gliomas, ependymomasQ
Nevoid basal cell carcinoma
PTC
9q22.3
Basal cell carcinoma
Peutz-Jeghers syndrome
STK11Q
19 p13.3Q
Gastrointestinal carcinomas, breast cancer, testicular cancer, pancreatic cancer, benign pigmentation of skin and mucosaQ
Retinoblastoma
RBQ
13 q14Q
Retinoblastoma, sarcomas, melanoma, malignant neoplasms of the brain and meningesQ
Tuberous sclerosis
TSC1
9 q34
Multiple hamartomas, RCC, astrocytoma
TSC2
16 p13
von Hippel-Lindau syndrome
VHLQ
3 p25Q
RCC, hemangioblastomas of retina and CNS, pheochromocytomaQ
Wilms’ tumor
WTQ
11 p13Q
Wilm's tumor, aniridia, genitourinary abnormalities, mental retardationQ
fm24Annexure 12
 
SUTURES
Suture
Types
Raw material
Tensile strength
Absorption rate
Silk
Braided or twisted multifilament; Coated (with wax or silicone) or uncoated
Natural protein
Raw silk from silkworm
Loses 20% when wet; 80–100% lost by 6 months
Fibrous encapsulation in body at 2–3 weeks; Absorbed slowly over 1–2 yearQ
Catgut
Plain
Collagen derived from healthy sheep or catle
Lost within 7–10 days
Phagocytosis and enzymatic degradation within 7–10 daysQ
Catgut
Chromic
Tanned with chromium salts to improve handling and resist degradation in tissueQ
Lost within 21–28 days
Phagocytosis and enzymatic degradation within 90 days
Polyglactin (Vicryl)
Braided multifilament
Copolymer of lactide and glycolideQ in a ratio of 90:10, coated with polyglactin and calcium stearate
Approx, 60% remains at 2 weeks; 30% remains at 3 weeks
Hydrolysis minimal until 5-6 weeks; Complete absorption 60-90 daysQ
Polyglyconate
Monofilament Dyed or undyed
Copolymer of glycolic acid and trimethylene carbonateQ
Approx, 70% remains at 2 weeks; 55% remains at 3 weeks
Hydrolysis minimal until 8-9 weeks; Complete absorption 180 daysQ
Polyglycaprone
Monofilament
Coplymer of glycolite and caprolactoneQ
21 days maximum
90–120 daysQ
Polyglycolic acid (Dexon)
Braided multifilament
Dyed or undyed
Coated or Uncoated
Polymer of polyglycolic acidQ
Approx, 40% remains at 1 weeks; 20% remains at 3 weeks
HydrolysisQ minimal at 2 weeks; significant at 4 weeks; Complete absorption 60–90 daysQ
Polydioxanone (PDS)
Monofilament dyed or undyed
Polyester polymerQ
Approx, 70% remains at 2 weeks; 50% remains at 4 weeks; 14% remains at 8 weeks
Hydrolysis minimal at 90 days; Complete absorption 180 daysQ
Guidelines for Day of Suture Removal by Area
Body Regions
Removal
Body Regions
Removal
Eyelid
3–4
Chest, abdomen
8–10
Eyebrow
3–5
Ear
10–14
Nose
3–5
Back
12–14
Lip
3–4Q
Extremities
12–14
Face (other)
3–4Q
Hand
10–14
Scalp
6–8Q
Foot, sole
12–14
fm25Annexure 13
 
NEW DRUGS IN SURGERY
New Drugs in CA Breast
Ixabepilone
  • Used for antracycline and taxane resistant breast cancerQ
Lapatinib
  • Inhibitor of Her-2-neu and EGFR tyrosine kinase
  • Second line Her-2-neu therapyQ
Sunitinib
  • Approved for advanced renal cancer and refractory metastatic breast cancerQ
New Drugs
Drug
Indication
Imatinib mesylate
  • GIST
  • CML
Sunitinib
  • Imatinib resistant GIST
  • Advanced Renal cancer
  • Refractory metastatic breast cancerQ
Sorafenib
  • Unresectable HCCQ
Geftinib
  • Adenocarcinoma lung in non-smoking females
Lapatinib
  • Inhibitor of Her-2-neu and EGFR tyrosine kinase
  • Second line Her-2-neu therapyQ
Annexure 14
 
INHERITANCE PATTERN
Autosomal dominant
Autosomal Recessive
X-Linked Disorders
  • Familial hypercholesterolemia
  • HNPCC
  • FAPQ
  • BRCA1 and BRCA2 breast cancer
  • Hereditary hemorrhagic telengiectasia
  • Marfan's syndromeQ
  • Hereditary spherocytosisQ
  • Adult polycystic kidney disease
  • Huntington's choreaQ
  • Acute intermittent porphyriaQ
  • Osteogenesis imperfectaQ
  • von Willebrand's diseaseQ
  • Myotonic dystrophyQ
  • Familial hypertrophic cardiomyopathy
  • NeurofibromatosisQ
  • Tuberous sclerosisQ
  • OtospongiosisQ
  • AchondroplasiaQ
  • Deafness
  • AlbinismQ
  • Wilson's diseaseQ
  • HemochromatosisQ
  • Sickle cell anemiaQ
  • beta thalassemia Q
  • Cystic fibrosisQ
  • Hereditary emphysema (α1 antitrypsin deficiency)
  • HomocystinuriaQ
  • Freidrich's ataxiaQ
  • PhenylketonuriaQ
  • Fanconi's Syndrome
  • Gaucher's Disease
  • Hemophilia AQ (recessive)
  • G6PD deficiencyQ (recessive)
  • Ducchene/Becker muscular dystrophyQ (recessive)
  • Fabry's disease
  • Ocular albinism
  • Testicular feminization
  • Chronic granulomatous disease
  • Hypophosphatemic ricketsQ (dominant)
  • Fragile-X syndromeQ (recessive)
  • Color blindnessQ
fm26Annexure 15
 
MOST COMMON TYPE OF STONES
Most Common Type of Stones
Gall bladder
CholesterolQ (Mixed if given in the option)
Pancreas
Calcium carbonateQ
Kidney
Calcium oxalateQ
Primary Bladder Stone
Ammonium urateQ
Secondary Bladder Stone
Uric acid >StruviteQ
Prostate
Calcium phospahteQ
Salivary gland (Submandibular)
Calcium carbonateQ
Annexure 16
 
NAMED HERNIA
Gibbon's hernia
  • Hernia with hydroceleQ
Berger's hernia
  • Hernia into pouch of DouglasQ
Beclard's hernia
  • Femoral hernia through opening of saphenous veinQ
Amyand's hernia
  • Inguinal hernia containing appendixQ
Ogilive's hernia
  • Hernia through the defect in conjoint tendon just lateral to where it inserts with the rectus sheathQ
Stammer's hernia
  • Internal hernia occurring through window in the transverse mesocolon after retrocolic gastrojejunostomyQ
Peterson hernia
  • Hernia under Roux limb after Roux-en-Y gastric bypassQ
Annexure 17
 
Ideal time for Treatment
Ideal time for Treatment
Undesended testis
6 monthsQ
Hypospadias
6–12 monthsQ
Umbilical hernia
5 yearsQ
Cleft lip
3–6 monthsQ
Cleft palate
6–18 monthsQ
fm27Annexure 18
 
INVESTIGATION OF CHOICE
Investigation of Choice
Barium swallow
Hiatus herniaQ
Zenkers diverticulaQ
LeiomyomaQ
Barium meal
Gastric diverticulaQ
Barium meal follow-through
Small bowel diverticulaQ
Enteroclysis
Crohn's diseaseQ
Barium enema
Colonic diverticulaQ
CECT
DivericulitisQ
GISTQ
Mesenteric cystQ
GI tuberculosisQ
Acute pancreatitisQ
Chronic pancreatitisQ
Carcinoma pancreasQ
Pancreatic pseudocystQ
Carcinoma gall bladderQ
Hepatocellular carcinomaQ (Triple phase CT)
Renal cell carcinomaQ
Retroperitoneal fibrosisQ
Retroperitoneal sarcomaQ
Renal tuberculosisQ
ADPKDQ
MRI
Brain tumorsQ
Spinal cord tumorsQ
Pancoast tumorQ
Soft tissue sarcomaQ
Staging of carcinoma penisQ
Endoscopy with biopsy
Barrett's esophagusQ
Carcinoma esophagusQ
Carcinoma stomachQ
Colonoscopy with biopsy
Carcinoma colonQ
Sigmoidoscopy with bioopsy
Carcinoma rectumQ
Proctoscopy with biopsy
Carcinoma anal canalQ
Cystoscopy with biopsy
Carcinoma bladderQ
FNAC
Carcinoma breastQ
Parotid tumorsQ
Thyroid malignaniesQ
Biopsy
Skin malignanciesQ
Carcinoma penisQ
Oral cavity malignanciesQ
Manometry
Achalasia cardiaQ
Diffuse esophageal spasmQ
Nutcrackers esophagusQ
24-hours pH monitoring
GERDQ
Somatostatin receptor scintigraphy
(IOC for localization)
All neuroendocrine tumors of pancreas except insulinomaQ
Carcinoid tumorsQfm28
Ultrasound
GallstonesQ
Acute cholecystitisQ
Chronic cholecystitisQ
Investigation of Choice
Acute mesenteric ischemia
  • AngiographyQ
Mesenteric venous thrombosis
  • CECTQ
Chronic mesenteric ischemia
  • AortographyQ
Investigation of Choice
ADPKD
Retroperitoneal Fibrosis
CT scanQ
Medullary Sponge Kidney
IVPQ
VUR
MCUQ
Retrocaval ureter
MRIQ
PUJ Obstruction
DTPA scanQ
Renal structure or surface
DMSA scanQ
Annexure 19
 
TUMOR MARKERS
Markers
Associated Cancers
Non-neoplastic Conditions
Hormones
  • Human chorionic gonadotropin
  • Calcitonin
  • Catecholamines
  • Trophoblastic tumorsQ, nonseminomatous testicular tumors
  • Medullary carcinomaQ of thyroid
  • PheochromocytomaQ
  • Pregnancy
Oncofetal Antigens
  • Alpha-Fetoprotein
  • CEA
  • LiverQ cell cancer, nonseminomatousQ germ cell tumor of testis, lungQ cancer
  • Adenocarcinoma of the colonQ, pancreasQ, lungQ, breastQ, ovaryQ, prostateQ
  • Cirrhosis, hepatitis
  • Pancreatitis, hepatitis, inflammatory bowel disease, smoking
Isoenzymes
  • Prostatic acid phosphatase
  • Neuron-specific enolase
  • Lactate dehydrogenase
  • Prostate cancer
  • Small cell cancer of lungQ, NeuroblastomaQ
  • Lymphoma, Ewing sarcoma
  • Prostatitis, prostatic hypertrophy
  • Hepatitis, hemolytic anemia, many others
Specific proteins
  • Immunoglobulins
  • PSA and prostate specific membrane antigen
  • Multiple myelomaQ and other gammopathies
  • Prostate cancerQ
  • Infection, MGUS
  • Prostatitis, prostatic hypertrophyQ
Mucins and other Glycoproteins
  • CA-125
  • CA-19-9
  • CD30
  • CD25
  • Cancer of ovaryQ, fallopian tube, endometriumQ, cervix, breastQ, lungQ, pancreasQ and colonQ
  • ColonQ cancer, pancreaticQ cancer
  • Hodgkin's diseaseQ, anaplastic large cell lymphoma
  • Hairy cell leukemia, adult T cell leukemia/lymphomaQ
  • PregnancyQ, endometriosisQ, PIDQ, uterine fibroidsQ
  • Pancreatitis, Ulcerative colitis
fm29Annexure 20
 
MOST COMMON
Small-Bowel Neoplasm
  • MC tumor of small bowel: LeiomyomaQ >AdenomaQ
  • MC tumor of small bowel in children: LymphomaQ
  • MC malignant tumor of small bowel: Carcinoid >AdenocarcinomaQ
  • MC site of small bowel malignancy, carcinoids, lymphoma: IleumQ
  • MC site of carcinoid tumors or distribution (BIRACS)Q: B ronchus> I leum > R ectum > A ppendix > C olon > S tomach
Liver Neoplasm
  • MC malignancy of liver: MetastasisQ
  • MC primary malignancy of liver: HCCQ
  • MC primary malignancy of liver in children: HepatoblastomaQ
  • MC benign tumor of liver: HemangiomaQ
  • MC complication of both end and loop colostomy: Parastomal herniaQ
  • Complications (both parastomal hernia and prolapse) are more common in loop colostomyQ as compared to end colostomy.
  • MC complication of ileostomy: Skin irritationQ
  • MC early complication of ileostomy: Ischemic necrosisQ
Indications of Liver Transplantation
  • MC indication for LT: Cirrhosis from Hepatitis C (HCV) Q
  • 2nd MC indication for LT: Alcoholic liver diseaseQ
  • MC indication for LT in children: Biliary atresiaQ
  • MC metabolic disorder requiring LT: Alpha-1 antitrypsin deficiencyQ
  • MC indication for LT following acute liver failure: Acetaminophen toxicityQ
Pediatric Tumors
  • MC malignant tumor of infancy
  • MC extracranial solid tumor in children
  • MC abdominal malignancy in children
NeuroblastomaQ
  • MC primary malignant renal tumor of childhood
Wilm's tumorQ
  • MC renal tumor of infancy
Congenital mesoblastic nephromaQ
  • MC soft tissue tumor in infants and children
RhabdomyosarcomaQ
  • MC solid tumor of childhood
Brain tumorQ
  • MC cancer of childhood
LeukemiaQ (30%) >Brain tumorsQ (22%)
  • MC cancer in males (PLC): Prostate >Lung >ColorectalQ
  • MC cancer in females (BLC): Breast >Lung >ColorectalQ
  • Cancer deaths in males (LPC): Lung >Prostate >ColorectalQ
  • Cancer deaths in females (LBC): Lung >Breast >ColorectalQ
fm30Annexure 21
 
MISCELLANEOUS
  • Widest portion of colon: CecumQ
  • Narrowest portion of colon: SigmoidQ
  • MC site of colonic rupture caused by distal obstruction: CecumQ
  • Colon absorbs water, NaClQ; secretes K+, HCO3 and mucusQ
  • MC site of ischemic colitis: Splenic flexure
Sarcomas with Lymph Node Metastasis (MARCES)
  • M alignant fibrous histiocytomaQ
  • A ngiosarcomaQ
  • R habdomyosarcomaQ
  • C lear cell sarcomaQ
  • E pithelial sarcomaQ
  • S ynovial sarcomaQ
Tumors with Spontaneous Regression (NCR MR)
  • N euroblastomaQ
  • C horiocarcinomaQ
  • R enal cell carcinomaQ
  • M alignant melanomaQ
  • R etinoblastomaQ
Malignancies associated with Migratory Thrombophlebitis
  • CA pancreas (MC)Q
  • CA lungQ
  • GI malignanciesQ
  • Prostate cancerQ
  • Ovarian cancerQ
  • LymphomaQ
  • Trousseau's syndrome: Migratory thrombophlebitisQ
  • Trousseau's sign: Carpopedal spasm in hypocalcemiaQ
  • Troisier's sign: Palpable left supraclavicular LN (Virchow's node)Q
Condition
Seen in
Necrolytic erythema migrans
  • Glucagonoma
Erythema chronicum migrans
  • Lyme's disease
Erythema infectiosum (fifth disease)
  • Parvovirus B19
Erythema marginatum
  • Acute rheumatic fever
Perineural Spread is seen in
1. Adenoid cystic carcinomaQ
2. CA GBQ
3. CholangiocarcinomaQ
4. Ductal adenocarcinoma of pancreasQ
Small Round Blue Cell Tumors (WEL PNR)
  • Wilm's tumor
  • Ewing's sarcoma
  • Lymphoma
  • Medulloblastoma
  • Small cell variant of osteosarcoma
  • Primitive neuroectodermal tumor
  • Neuroblastoma
  • Rhabdomyosarcoma
  • Askin tumor
  • Desmoplastic small cell tumor
Causes of Postoperative Fever
Day
Cause
2–5 days
  • Atelectasis of the lungQ
3–5 days
  • Superficial and deep wound infectionQ
5 days
  • Chest infection including viral respiratory tract infection, UTI and thrombophlebitisQ
>5 days
  • Wound infection, anastomotic leakage, intracavitary collections and abscessesQ
fm31New Recommendations
  • Aspirin need not be stopped before surgeryQ
  • Thyroid medications should be continuedQ
  • Anti-hypertensives should be continued (even losartan) Q
  • OCPs should be continued till day of surgeryQ
  • Anti-depressants, anti-epileptics, anti-psychotics should be continued except TCA, which should be stopped 3 weeks before surgery due to risk of intra operative arrhythmiaQ
  • Ticlopidine: 14 days before surgeryQ
  • Clopidogrel: 7 days before surgeryQ
  • Warfarin: 3 days before surgeryQ
  • LMWH: 12 hours before surgeryQ
Increased Cancer Risk in Obese Patients (PEEL CP GO KBC)
  • ProstateQ
  • EndometrialQ
  • EsophagusQ
  • LiverQ
  • CervixQ
  • PancreasQ
  • Gall BladderQ
  • OvarianQ
  • KidneyQ
  • Bile ductQ
  • BreastQ
  • Colon and rectumQ
Psammoma Bodies (PSM)
1. P apillary carcinoma thyroidQ
2. P apillary carcinoma (RCC) Q
3. S erous cystadenomaQ
4. M eningiomaQ
Proctoscope
10–12 cmQ
Rigid sigmoidoscope
25 cmQ
Flexible sigmoidoscope
60 cmQ
Colonoscope
160 cmQ
Most radiosensitive ovarian tumor
  • DysgerminomaQ
Most radiosensitive brain tumor
  • MedulloblastomaQ
Most radiosensitive testicular tumor
  • SeminomaQ
Most radiosensitive lung tumor
  • Small cell CAQ
Most radiosensitive kidney tumor
  • Wilms tumorQ
Most radiosensitive bone tumor
  • Ewing's SarcomaQ and Multiple myelomaQ
Condition
Seen in
Necrolytic erythema migrans
  • Glucagonoma
Erythema chronicum migrans
  • Lyme's disease
Erythema infectiosum (fifth disease)
  • Parvovirus B19
Erythema marginatum
  • Acute rheumatic fever
Screening Immunohistochemistry
  • Epithelial Markers: Cytokeratin (positive in carcinomas)Q
  • Lymphoid Markers: CD-45 (positive in lymphoma)Q
  • Melanocytic Markers: S-100 (positive in melanoma)Q
  • Mesenchymal Markers: Vimentin (positive in sarcoma)Q
  • Neuroendocrine Markers: Chromagranin and neuron specific enolaseQ