Final MBBS Surgery Theory - Complete Unit-Wise Question Bank

Covers all major Indian university patterns (NMC/MCI syllabus, RGUHS, MUHS, KUHS, DU, WBUHS, etc.)

UNIT 1 - SURGICAL INFECTIONS & WOUNDS

Long Answer Questions (LAQ - 10 marks)

1. Classify surgical infections. Discuss the pathophysiology, clinical features, and management of gas gangrene.
2. Enumerate the types of surgical wounds. Discuss wound healing by primary and secondary intention. What are the factors affecting wound healing?
3. Discuss the etiopathogenesis, clinical features, and management of necrotizing fasciitis.
4. Describe the types, bacteriology, clinical features, and management of tetanus.
5. Classify abscesses. Discuss the management of a deep-seated abscess.

Short Answer Questions (SAQ - 5 marks)

• Principles of antibiotic prophylaxis in surgery
• Wound classification (CDC classification)
• Biofilm and surgical site infections
• MRSA infections - management
• Clostridium difficile colitis
• Cellulitis vs erysipelas
• Fournier's gangrene
• Surgical site infection (SSI) - prevention
• Keloid vs hypertrophic scar
• Vacuum-assisted closure (VAC) therapy

UNIT 2 - FLUID, ELECTROLYTES & NUTRITION

Long Answer Questions

1. Classify body fluid compartments. Discuss the causes, clinical features, diagnosis, and management of hyponatremia.
2. Discuss the pathophysiology and management of a patient with intestinal fistula - emphasize on fluid, electrolyte, and nutritional management.
3. Classify shock. Describe the pathophysiology, clinical grading, and management of hypovolemic shock.
4. Discuss the indications, routes, components, and complications of Total Parenteral Nutrition (TPN).

Short Answer Questions

• Crystalloids vs colloids - surgical use
• ABCD of resuscitation
• Hyperkalemia - ECG changes and management
• Metabolic acidosis vs alkalosis
• Enteral nutrition - advantages over TPN
• Complications of blood transfusion
• Albumin in surgical patients
• Oliguria in postoperative patient - approach
• SIADH
• Refeeding syndrome

UNIT 3 - TRAUMA & BURNS

Long Answer Questions

1. Classify burns. Discuss the rule of nines, pathophysiology of burn injury, Parkland formula for fluid resuscitation, and management of a patient with 40% TBSA burns.
2. Define polytrauma. Describe ATLS protocol for primary and secondary survey in a road traffic accident victim.
3. Discuss the management of a patient with closed head injury - include indications of CT scan, surgical indications, and monitoring.
4. Classify traumatic injuries to the spleen. Describe non-operative and operative management of splenic trauma.

Short Answer Questions

• Rule of nines vs Lund and Browder chart
• Escharotomy - indications and technique
• Blast injury - classification
• Compartment syndrome - diagnosis and fasciotomy
• FAST examination in trauma
• Diaphragmatic injury
• Traumatic aortic injury
• Penetrating abdominal trauma management
• Seat belt injury pattern
• Damage control surgery

UNIT 4 - SURGICAL ONCOLOGY

Long Answer Questions

1. Discuss the principles of staging in surgical oncology. Describe the TNM staging system with examples.
2. Classify paraneoplastic syndromes. Describe the role of surgery, chemotherapy, and radiation in multimodal cancer management.
3. Discuss tumor markers - their types, clinical utility, and limitations with examples.
4. Describe the etiology, pathology, clinical features, investigations, and management of carcinoma esophagus.

Short Answer Questions

• Tumor markers and their clinical use (CEA, AFP, PSA, CA 125, CA 19-9)
• Sentinel lymph node biopsy - principle and technique
• Palliative surgery vs curative surgery
• Radiotherapy - types and indications in surgery
• Targeted therapy in cancer (EGFR, HER2, VEGF)
• Chemotherapy - mechanisms and surgical implications
• Carcinoid tumor
• GIST (Gastrointestinal Stromal Tumor)
• Port-a-cath / PICC line
• Photodynamic therapy

UNIT 5 - BREAST

Long Answer Questions

1. Classify breast lumps. Describe the clinical features, investigations, and management of carcinoma breast.
2. Describe FNAC, core biopsy, and triple assessment in evaluation of a breast lump.
3. Discuss the evolution of surgical procedures for carcinoma breast - from radical mastectomy to breast conserving surgery. What are the indications of each?
4. A 45-year-old woman presents with a 3 cm hard lump in the upper outer quadrant of right breast. Describe your approach to diagnosis and management.

Short Answer Questions

• Breast conserving surgery - indications and contraindications
• Sentinel lymph node biopsy in breast cancer
• Paget's disease of nipple
• Phyllodes tumor
• Gynaecomastia - causes and management
• Mammography - indications and interpretation
• BRCA 1 and BRCA 2 - surgical implications
• Ductal carcinoma in situ (DCIS)
• Fibroadenoma - management
• Mondor's disease

UNIT 6 - THYROID & PARATHYROID

Long Answer Questions

1. Classify goiter. Discuss the etiology, clinical features, investigations, and management of toxic multinodular goiter.
2. Differentiate between primary, secondary, and tertiary hyperparathyroidism. Describe the management of primary hyperparathyroidism.
3. Describe the clinical features, staging, and management of well-differentiated thyroid carcinoma (papillary and follicular).
4. Discuss the complications of thyroidectomy - immediate, early, and late.

Short Answer Questions

• Solitary thyroid nodule - approach
• Thyroid storm - triggers, features, and management
• Recurrent laryngeal nerve - anatomy and injury
• Prophylactic central neck dissection in papillary thyroid cancer
• Hurthle cell tumor
• Medullary carcinoma thyroid and MEN syndromes
• Total thyroidectomy vs hemithyroidectomy - indications
• Hypoparathyroidism after thyroidectomy
• Ectopic thyroid
• Radioactive iodine therapy

UNIT 7 - ESOPHAGUS & STOMACH

Long Answer Questions

1. Classify peptic ulcer disease complications. Describe the management of a patient presenting with perforated duodenal ulcer.
2. Discuss the pathophysiology, grading, endoscopic findings, and management of gastroesophageal reflux disease (GERD).
3. Describe the surgical management of morbid obesity - types of bariatric procedures, indications, and complications.
4. Discuss the clinical features, staging (Siewert classification), and management of carcinoma gastroesophageal junction.

Short Answer Questions

• Dumping syndrome - early and late
• Bariatric surgery - types and complications
• H. pylori - role in peptic ulcer and treatment
• Achalasia cardia - pathophysiology and management
• Carcinoma stomach - staging and management
• Gastrectomy - types (Billroth I, II, Roux-en-Y)
• Zollinger-Ellison syndrome
• Mallory-Weiss tear
• Esophageal varices - management
• Corrosive injuries of esophagus

UNIT 8 - SMALL BOWEL, APPENDIX & COLON

Long Answer Questions

1. Describe the pathology, clinical features, complications, and management of Crohn's disease vs ulcerative colitis.
2. Classify intestinal obstruction. Discuss the clinical features, investigations, and management of acute intestinal obstruction due to adhesions.
3. Describe the Hartmann's procedure - indications, technique, and reversal.
4. Discuss the presentation, diagnosis, and management of colorectal carcinoma including screening programs.

Short Answer Questions

• Appendicitis - Alvarado score and management
• Meckel's diverticulum - rule of 2s and complications
• Short bowel syndrome - causes and management
• Intussusception - clinical features and management
• Colostomy - types, indications, and complications
• ERAS protocol (Enhanced Recovery After Surgery)
• Toxic megacolon
• Pseudo-obstruction (Ogilvie's syndrome)
• Carcinoid of appendix
• Diverticulitis - Hinchey classification and management

UNIT 9 - RECTUM & ANAL CANAL

Long Answer Questions

1. Classify hemorrhoids. Describe the clinical features and management including Lord's procedure, rubber band ligation, hemorrhoidectomy, and MIPH (stapler).
2. Classify fistula-in-ano. Describe the anatomy of anorectal spaces, pathogenesis, and surgical options for complex fistulas.
3. Discuss the classification, clinical features, investigations, and management of carcinoma rectum including TME (Total Mesorectal Excision).
4. Describe anterior resection of rectum - indications, technique, and complications.

Short Answer Questions

• Anal fissure - pathophysiology and management
• Parks' classification of fistula-in-ano
• Abdominoperineal resection (APR) - indications
• Pilonidal sinus - etiology and management
• Rectal prolapse - types and management
• Anal incontinence - causes and management
• Goodsall's rule
• Perianal abscess - spaces and management
• Neoadjuvant chemoradiation in rectal cancer
• Defunctioning loop ileostomy

UNIT 10 - LIVER, BILIARY SYSTEM & PANCREAS

Long Answer Questions

1. Classify jaundice. Describe the clinical approach, investigations, and management of obstructive jaundice due to choledocholithiasis.
2. Discuss the etiology, pathogenesis, clinical features, and management of acute pancreatitis. Include Atlanta classification and Revised Atlanta classification.
3. Describe the clinical features, complications, and management of portal hypertension.
4. Discuss carcinoma head of pancreas - clinical features, Courvoisier's sign, investigations (double duct sign), staging, and Whipple's procedure.

Short Answer Questions

• Courvoisier's law - exceptions
• ERCP - indications, complications
• Mirizzi syndrome
• Cholangiocarcinoma - Bismuth classification
• Choledochal cyst - classification and management
• Hepatocellular carcinoma - screening and TACE
• Pyogenic liver abscess vs amoebic liver abscess
• Hydatid cyst of liver - PAIR procedure
• Chronic pancreatitis - management (Puestow's procedure)
• Pseudocyst of pancreas - management

UNIT 11 - HERNIAS

Long Answer Questions

1. Classify hernias. Describe the anatomy of inguinal canal. Discuss the differences between direct and indirect inguinal hernia and their surgical repair (Lichtenstein, Bassini, Shouldice, TEP/TAPP).
2. Describe the clinical features and management of obstructed vs strangulated hernia.
3. Discuss incisional hernia - predisposing factors, classification, and mesh repair options (onlay, sublay, IPOM).
4. Describe femoral hernia - anatomy, differences from inguinal hernia, and management.

Short Answer Questions

• Laparoscopic inguinal hernia repair (TEP vs TAPP)
• Sliding hernia
• Richter's hernia
• Spigelian hernia
• Littre's hernia
• Obturator hernia
• Para-umbilical hernia - management
• Mesh types - classification
• Hesselbach's triangle
• Complications of hernia surgery

UNIT 12 - VASCULAR SURGERY

Long Answer Questions

1. Classify peripheral arterial disease. Describe the clinical features, ankle-brachial index (ABI), investigations, and management of chronic limb-threatening ischemia.
2. Discuss the etiology, pathophysiology, clinical features, and management of deep vein thrombosis (DVT) and pulmonary embolism.
3. Describe the clinical features, investigations, and management of abdominal aortic aneurysm (AAA) - including endovascular repair (EVAR) vs open repair.
4. Classify varicose veins (CEAP). Describe clinical features, investigations (duplex ultrasound), and management (EVLA, foam sclerotherapy, surgery).

Short Answer Questions

• Fontaine's classification of peripheral arterial disease
• Virchow's triad
• Carotid artery disease - indications for endarterectomy
• Raynaud's phenomenon vs disease
• Buerger's disease (TAO) - management
• Venous ulcer vs arterial ulcer vs diabetic ulcer
• EVAR - indications and complications
• Thoracic outlet syndrome
• Acute limb ischemia - 6 Ps
• Subclavian steal syndrome

UNIT 13 - UROLOGICAL SURGERY

Long Answer Questions

1. Classify renal calculi. Describe the metabolic workup, investigation, and management of renal colic - include ESWL, PCNL, ureteroscopy indications.
2. Discuss the clinical features, staging (TNM), and management of carcinoma bladder.
3. Describe benign prostatic hyperplasia (BPH) - pathology, IPSS score, investigations, medical and surgical management (TURP, HoLEP).
4. Discuss carcinoma prostate - PSA screening controversy, Gleason score, staging, and management.

Short Answer Questions

• Testicular torsion vs epididymo-orchitis
• Wilms' tumor (nephroblastoma) - presentation and management
• Hydronephrosis - causes and management
• Renal cell carcinoma - paraneoplastic features and management
• Bladder outlet obstruction - flowmetry
• Ureteric injuries - intraoperative management
• Hypospadias - classification and repair
• Varicocele - diagnosis and treatment
• Undescended testis - complications and management
• Urethral stricture - urethroplasty

UNIT 14 - NECK SWELLINGS & SALIVARY GLANDS

Long Answer Questions

1. Give a surgical approach to a patient with midline neck swelling. Discuss the differential diagnosis and management.
2. Classify parotid gland tumors. Discuss the clinical features and management of pleomorphic adenoma and Warthin's tumor. Describe superficial parotidectomy.
3. Discuss the etiology, clinical features, investigations, and management of branchial cyst, branchial sinus, and branchial fistula.
4. Describe cervical lymphadenopathy - causes, investigations, and when to do lymph node biopsy vs FNAC.

Short Answer Questions

• Thyroglossal cyst - Sistrunk's operation
• Cystic hygroma (lymphatic malformation) - management
• Frey's syndrome (auriculotemporal nerve syndrome)
• Submandibular gland calculi - management
• Parotid fistula
• Ranula - types and management
• Carotid body tumor (chemodectoma)
• Neck dissection - types (radical, modified, selective)
• Ludwig's angina
• Sternomastoid tumor (SCM fibrosis)

UNIT 15 - DAY CARE SURGERY, ANAESTHESIA & PREOPERATIVE ASSESSMENT

Short Answer Questions

• Day care surgery - indications, criteria (ASA classification), and discharge criteria
• Preoperative assessment of a patient with IHD for elective surgery
• Informed consent in surgery
• Types of anaesthesia - GA vs regional vs local
• Malignant hyperthermia - trigger agents and management
• Postoperative fever - timing and causes (5 Ws)
• ICU monitoring parameters
• Scoring systems in ICU (APACHE, SOFA, SAPS)
• Surgical safety checklist (WHO)
• Laser safety in operating theatre

UNIT 16 - LAPAROSCOPY & MINIMALLY INVASIVE SURGERY

Short Answer Questions

• Physiological effects of pneumoperitoneum
• Contraindications of laparoscopic surgery
• Port site complications
• Single incision laparoscopic surgery (SILS)
• Robotic surgery - advantages and limitations
• NOTES (Natural Orifice Transluminal Endoscopic Surgery)
• Laparoscopic cholecystectomy - critical view of safety
• Trocar injury - types and management
• Energy devices in laparoscopic surgery (harmonic scalpel, LigaSure)
• Conversion from laparoscopic to open surgery

UNIT 17 - ORTHOPAEDICS (Allied Surgery)

Long Answer Questions

1. Classify fractures. Describe the healing of a long bone fracture. Discuss the complications of fracture healing.
2. Discuss the clinical features and management of fracture neck of femur in an elderly patient.
3. Describe the clinical features, investigations, and management of acute osteomyelitis vs septic arthritis.
4. Discuss osteoarthritis of the knee - clinical features, grading (K-L grading), conservative and surgical management (TKR).

Short Answer Questions

• Compartment syndrome - diagnosis and fasciotomy
• RICE therapy and principles of fracture management
• Volkmann's ischaemic contracture
• Colles' fracture vs Smith's fracture
• Supracondylar fracture humerus - cubitus varus
• Avascular necrosis - sites and causes
• External fixators - types and indications
• Bone tumors - classification (benign vs malignant)
• Osteosarcoma - management
• Pott's spine (spinal TB) - Hodgson's procedure

RECURRING EXAM FAVORITES (Must Know)

TIPS FOR WRITING SURGERY ANSWERS

1. LAQ structure: Definition → Classification → Etiopathogenesis → Clinical features → Investigations → Management (medical + surgical) → Complications → Prognosis
2. Draw diagrams: Always draw for hernias, anorectal anatomy, thyroid, breast, vascular anatomy - marks are given specifically for diagrams
3. Tables: Use comparison tables for differentials (e.g., Crohn's vs UC, ulcer types, jaundice types)
4. Recent guidelines: Mention ERAS, WHO checklist, damage control surgery wherever relevant
5. Operative steps: For surgical procedures, write key steps in numbered format
6. Classify first: Start every answer with a classification - examiners look for this