SURGERY portion for Internals ( final year MBBS ) please tell me how to approach. 3rd August Internals begin.

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Surgery Internals Preparation Guide - Final Year MBBS (2022 Batch)

Internals: 3rd August 2026 | Today: 16th June 2026 | Time left: ~47 days

How Your Syllabus Breaks Down

You have 40 Lectures + 79 Tutorials covering Jan-July 2026. For internals starting 3rd August, the examiners will draw from the entire taught syllabus. Here is what you actually need to focus on.

PRIORITY TIER SYSTEM

🔴 TIER 1 - High-Yield (Almost Always Asked)

These are the classic surgery "bread and butter" topics. Every internal exam tests these heavily.

Topic	Lecture/Tutorial	Key Competency Code
Thyroid swellings - full workup, management, thyroid cancer	L36, T025-027	SU22.1-22.4
Hernia - inguinal anatomy, Hesselbach's triangle, open vs lap repair	L26, L27, T (SU28.1)	SU28.1, AN44.5
Breast disease - benign + malignant, staging, management	T035-038	SU25.1-25.5
Pancreatitis - pathophysiology, Ranson's, Atlanta classification, management	L7, T071-072	SU24.1
Biliary system - cholelithiasis, cholecystitis, Mirizzi, CBD stones	L24, T057-058, T069-070	SU28.12
Burns - Rule of 9s, Parkland formula, Wallace, depth, management	T007-008	SU4.1-4.2
Shock - pathophysiology, types, resuscitation, fluid therapy	T003-004	SU2.1-2.2
Peritonitis - causes, clinical features, management	L12	SU28.3

🟡 TIER 2 - Frequently Asked (Very Likely)

Topic	Lecture/Tutorial	Key Code
Liver - abscess (amoebic vs pyogenic), hydatid cyst, tumors, injuries	L31, T043-044	SU28.10
Chest injuries - pneumothorax, haemothorax, flail chest, tension	L5, T047-048, T055	SU17.8-17.9
Abdominal injuries - solid vs hollow organ, FAST, DPL	L6	SU28.10-28.11
Splenic injuries - management, post-splenectomy sepsis	L32, T049-050	SU28.11
Portal hypertension - portosystemic anastomoses, caput medusae, Rx	L35	AN47.11
Varicose veins + DVT - anatomy, clinical features, complications	L22	SU27.6
Oral cancer - risk factors, staging, management, oral precancerous lesions	L34, L38, L40, T041-042	SU20.1-20.2
Carcinoma Stomach - etiology, features, investigations, surgery	L30	SU28.8
Peptic ulcer disease + HPSS	L29	SU28.8
Colon cancer + IBD	T063-068	SU28.13-28.14
Wound healing - normal + abnormal, factors affecting	T009-010	SU5.1-5.3
Surgical infections - types, antibiotics	T013-014	SU6.1-6.2

🟢 TIER 3 - Know the Basics

Topic	Code
Anesthesia - types, principles	SU11.2
Day care surgery	SU11.4
Minimal invasive surgery (laparoscopy)	SU16.1
Fluid and electrolyte management in surgical patients	SU12.2
Preoperative evaluation and perioperative care	SU1.3, SU10.1, SU11.1
Blood transfusion - indications, components, complications	SU3.1-3.2
Occlusive arterial disease + gangrene + amputation	SU27.1, SU27.4
Lymphedema, lymphangitis, lymphoma	SU27.7
Esophagus - benign + malignant disorders	SU28.5-28.6
Adrenal gland disorders	SU23.2
Lung tumors + mediastinal diseases	SU26.3-26.4
Pancreatic endocrine tumors + carcinoid	SU24.2-24.3
Testicular tumors + undescended testis	SU30.2, SU30.6
Organ transplantation - immunological basis	SU13.1
Cleft lip and palate	SU19.1
Salivary gland disorders	SU21.1-21.2
Anorectal diseases + congenital anomalies	SU28.16-28.17
Head injuries - GCS, neurological assessment	SU17.4-17.5
Cutaneous/subcutaneous infections, skin tumors	SU18.1-18.3
Neurofibromatosis	SU24.3
Hospital waste, sterilization, asepsis	SU14.1-14.2, SU15.1

47-DAY WEEK-BY-WEEK STUDY PLAN

Week 1 (June 16-22): Foundation + Tier 1 Block A

Day 1-2: Shock (types, stages, resuscitation, Starling's, hemorrhagic shock classes) + Fluid therapy
Day 3-4: Burns (Wallace rule of 9s, Lund & Browder, Parkland, complications, depth)
Day 5-6: Wound healing (phases, factors, keloid vs hypertrophic scar, debridement)
Day 7: Surgical infections (cellulitis, abscess, necrotizing fasciitis, gas gangrene) + antibiotics

Week 2 (June 23-29): Tier 1 Block B

Day 1-2: Thyroid - anatomy, physiology, goitre classification, investigation (USG, FNAC, TFTs), thyrotoxicosis management, thyroid cancer (papillary/follicular/medullary/anaplastic)
Day 3-4: Breast - ANDI classification, benign diseases, breast cancer (TNM, molecular subtypes, SLNB, mastectomy types)
Day 5-6: Hernia - Hesselbach's triangle, indirect vs direct inguinal, femoral, contents, Lichtenstein, TEP/TAPP
Day 7: Revision + make short notes

Week 3 (June 30 - July 6): GI Surgery Block A

Day 1-2: Pancreatitis - Ranson's criteria, Atlanta classification, severity, pancreatic necrosis, pseudocyst, role of surgery
Day 3-4: Biliary system - gallstones (types, risk factors), cholecystitis (acute/chronic), Mirizzi syndrome, cholangitis, cholangiocarcinoma, Courvoisier's law
Day 5-6: Peritonitis + intra-abdominal abscess + lesser sac
Day 7: Peptic ulcer disease + carcinoma stomach + HPSS

Week 4 (July 7-13): GI Surgery Block B + Trauma

Day 1-2: Liver - amoebic vs pyogenic abscess, hydatid cyst, HCC, hepatic trauma, Pringle manoeuvre
Day 3: Portal hypertension - anatomy, causes, portosystemic shunts, management
Day 4: Abdominal injuries + splenic injuries + post-splenectomy sepsis
Day 5-6: Chest injuries - open/tension/haemopneumothorax, flail chest, cardiac tamponade (Beck's triad)
Day 7: Head injuries + GCS + damage control surgery

Week 5 (July 14-20): Vascular + Colorectal + Esophagus

Day 1-2: Varicose veins + DVT (Virchow's triad, Homan's sign, management, LMWH)
Day 3: Occlusive arterial disease (Buerger's, atherosclerosis, Fontaine's classification, gangrene)
Day 4: Colon cancer (Duke's, TNM, FAP, HNPCC, CEA, management) + IBD
Day 5: Esophagus - GERD, achalasia, carcinoma esophagus (squamous vs adeno)
Day 6: Small intestine + neonatal obstruction + short gut
Day 7: Oral cancer + salivary glands

Week 6 (July 21-27): Endocrine + Miscellaneous

Day 1: Parathyroid disorders (hypercalcemia, MEN syndromes)
Day 2: Adrenal disorders (phaeochromocytoma, Conn's, Cushing's)
Day 3: Pancreatic endocrine tumors (insulinoma, Zollinger-Ellison, VIPoma, carcinoid)
Day 4: Lung tumors + mediastinal masses (anterior-4Ts mnemonic)
Day 5: Organ transplantation (rejection types, immunosuppression, HLA matching)
Day 6: Preoperative assessment + anesthesia + day care + MIS
Day 7: Anorectal diseases + testicular conditions

Week 7 (July 28 - Aug 2): Rapid Revision + VIVA Prep

Day 1-2: Revisit all Tier 1 topics - do 1-page summaries
Day 3: Short/important topics - cleft lip/palate, skin tumors, neurofibromatosis, blood transfusion
Day 4: Go through all Tutorial competency codes - spot any gaps
Day 5: Formulae and scores revision (Ranson, Alvarado, Glasgow-Blatchford, APACHE II, Wells score, Child-Pugh)
Day 6: Mock viva with common long cases (thyroid, breast, hernia, peritonitis, pancreatitis)
Day 7 (Aug 2): Light revision, rest well

INTERNALS FORMAT - WHAT TO EXPECT

Typical internal exam structure for Final Year Surgery:

Written MCQs / Short notes - 1-2 topics per Tutorial competency code
Clinical case discussion (viva) - Long case: examine a patient, present, answer questions
OSCE stations - May include: reading X-rays (CXR for pneumothorax, AXR for obstruction), interpreting LFTs/amylase, USG abdomen description

For viva, be ready to present any of these as a long case: Thyroid swelling / Breast lump / Inguinal hernia / Varicose veins / Obstructive jaundice / Peritonitis / Pancreatitis

TOP 10 SCORES AND FORMULAE TO MEMORISE

Score/Formula	Topic
Ranson's Criteria (5 on admission + 6 at 48h)	Pancreatitis severity
Child-Pugh Score (A/B/C)	Liver disease severity
Glasgow-Blatchford / Rockall	GI bleed risk
Wells Score	DVT / PE probability
Parkland Formula (4ml × kg × %TBSA)	Burns fluid resuscitation
Wallace Rule of 9s	Burns surface area
GCS (E4V5M6 = 15)	Head injury
Alvarado Score (MANTRELS)	Appendicitis
Fontaine Classification	PAD severity
Dukes / TNM staging	Colorectal cancer

QUICK-REFERENCE: COMPETENCY CODES FOR YOUR SYLLABUS

The NMC uses SU (Surgery), AN (Anatomy-Applied), FM (Forensic-relevant) codes throughout. In your tutorials you have codes up to SU30. Cross-reference these with Bailey & Love or Das's Surgery for the Indian context.

Recommended books for this syllabus:

Bailey & Love's Short Practice of Surgery - main reference
S. Das - A Concise Textbook of Surgery - excellent for Indian exam pattern, short notes format
Manipal Manual of Surgery - very useful for internals/viva quick reads
Schwartz's Principles - only if you need detailed understanding of a topic

IMPORTANT NOTES

Tutorials 71-79 are the last ones (till 29th July) - pancreatitis, testicular, IBD, GI syndromes, anorectal - these will definitely feature since they are taught just before internals.
Lectures 35-40 (Portal HTN, Thyroid, Fluids, Oral cancer, Transplantation) are from early-mid July - fresh in examiner's mind.
Applied anatomy questions are common - Hesselbach's triangle, thyroid anatomy, biliary anatomy, portal system, inguinal canal - know these cold.
Competency-based questions - Examiners often frame questions exactly from the competency statement (SU28.1, SU22.3, etc.). Read the exact wording in your Tutorial list - that IS the question they will ask.
You have 47 days - that is more than enough if you are systematic. Do NOT try to read everything. Work Tier 1 deeply, Tier 2 solidly, and Tier 3 at overview level.

Good luck - you have a solid roadmap now. Feel free to ask for deep dives on any specific topic!

it’s only theory exam. no viva and osce.

Got it - theory only. That changes the approach significantly. Here's the refined guide:

Surgery Internals - Theory Exam Strategy

Only Written Paper | 3rd August 2026 | 47 days left

What Theory Papers Test (Final Year Pattern)

Typical format:

Long answer questions (LAQ) - 10-15 marks | 2-3 questions
Short answer questions (SAQ) - 5 marks | 6-10 questions
MCQs - if included, 1 mark each

The examiner picks topics directly from the competency statements in your Tutorial/Lecture schedule. The exact phrasing of the tutorial IS the question.

How to Write Theory Answers - The Formula

For any LAQ (Long Answer):

Definition (1-2 lines)
Classification (always earns marks - use a table or numbered list)
Etiology / Etiopathogenesis
Clinical features (symptoms + signs)
Investigations (blood, imaging, special - in order)
Management (conservative → medical → surgical)
Complications (if asked or relevant)

Examiners give marks for structure and headings even if content is incomplete. Always write with bold headings.

For any SAQ (Short Answer):

Pick 2-3 of the above subheadings most relevant to the question. Write in 10-15 lines max with a small diagram or classification table if applicable.

What to Write For Each Tier 1 Topic

🔴 TIER 1 - Deep Preparation (Learn answer structure fully)

1. Thyroid swellings (SU22.1-22.4)

Classification of goitre (WHO grading)
Investigations: TFTs, USG neck, FNAC (Bethesda system), radioiodine scan
Thyrotoxicosis: Graves vs toxic MNG vs toxic adenoma - management (antithyroid drugs/radioiodine/surgery)
Thyroid cancer: papillary (most common, psammoma bodies), follicular (capsular/vascular invasion), medullary (MEN2, calcitonin), anaplastic (worst prognosis)
Write a table comparing the 4 cancers - guaranteed marks

2. Hernia (SU28.1, AN44.5)

Hesselbach's triangle boundaries (MEMORISE: inguinal ligament below, inferior epigastric vessels lateral, rectus sheath medial)
Indirect vs direct inguinal - difference table
Contents of inguinal canal (4 layers of spermatic cord, ilioinguinal nerve)
Lichtenstein (open mesh) vs TEP/TAPP (laparoscopic) - principles, advantages
Complications: incarceration, strangulation, Richter's hernia

3. Breast (SU25.1-25.5)

ANDI classification (fibroadenoma, fibrocystic change, duct ectasia)
Breast cancer: risk factors, TNM staging table, molecular subtypes (Luminal A/B, HER2+, Triple negative)
Management: lumpectomy + RT vs mastectomy, SLNB vs ALND, chemotherapy, hormone therapy (Tamoxifen/Aromatase inhibitors)
Draw triple assessment diagram (clinical + USG/mammogram + FNAC/biopsy)

4. Pancreatitis (SU24.1)

Causes: GET SMASHED mnemonic
Ranson's criteria table (5 on admission: age >55, WBC >16k, glucose >200, LDH >350, AST >250 | 6 at 48h)
Atlanta classification: mild/moderately severe/severe
Management: nil by mouth, IVF, analgesia, ERCP if CBD stone, surgery only for infected necrosis
Complications: pseudocyst, abscess, fistula, splenic vein thrombosis

5. Biliary system (SU28.12)

Gallstone types (cholesterol/pigment/mixed) - formation conditions
Courvoisier's Law (palpable GB + jaundice = not stones, likely malignancy)
Mirizzi syndrome: classification (Type I-IV)
Acute cholecystitis vs cholangitis (Charcot's triad vs Reynolds' pentad)
Management: laparoscopic cholecystectomy, ERCP + sphincterotomy for CBD stones

6. Shock (SU2.1-2.2)

Types: hypovolemic/distributive/cardiogenic/obstructive
Hemorrhagic shock classes (Class I-IV table: blood loss %, HR, BP, urine output, consciousness)
ATLS principles of resuscitation: 2 large bore IV, crystalloid initially, blood products (1:1:1 in massive hemorrhage)
Monitoring: urine output (0.5 ml/kg/hr adult), CVP, MAP

7. Burns (SU4.1-4.2)

Rule of 9s (Wallace) + Lund and Browder chart
Depth: superficial/partial thickness/full thickness - features table
Parkland formula: 4 ml × weight (kg) × %TBSA - first half in 8h, second half in 16h (Ringer's lactate)
Complications: Curling's ulcer (gastric), infection, contracture, inhalation injury

8. Peritonitis (SU28.3)

Primary (SBP in cirrhosis) vs secondary (perforated viscus) vs tertiary
Signs: board-like rigidity, guarding, rebound, absent bowel sounds
Investigations: erect CXR (free air under diaphragm), CT abdomen
Management: resuscitation, IV antibiotics, emergency surgery (4 aims: source control, lavage, closure/drainage, parenteral nutrition)

🟡 TIER 2 - Solid Preparation (Know classification + management outline)

For each of these, prepare a 1-page answer plan - you don't need to memorise every detail, but have a clear structure:

Topic	Must-Know Points
Liver abscess	Amoebic (RUQ pain, anchovy sauce pus, Rx metronidazole) vs pyogenic (polymicrobial, drainage needed)
Portal hypertension	Pre/intra/post hepatic causes; portosystemic anastomoses (5 sites); oesophageal varices management (vasoconstrictor + endoscopy + TIPS)
Chest injuries	Tension pneumothorax (needle at 2nd ICS MCL then ICC) vs open (3-sided dressing) vs haemothorax; Beck's triad for tamponade
Wound healing	3 phases (inflammatory/proliferative/remodelling); factors affecting healing table (local vs systemic); keloid vs hypertrophic scar
Carcinoma stomach	Lauren classification (intestinal vs diffuse); Virchow's node/Sister Mary Joseph nodule/Krukenberg; investigations; total/subtotal gastrectomy
Varicose veins + DVT	Virchow's triad; Trendelenburg test; Doppler USS; management (compression/LMWH for DVT); thrombolysis if massive PE
Colon cancer	Duke's A-D + TNM table; FAP/HNPCC (Lynch syndrome); CEA for surveillance, not diagnosis; right vs left sided differences
Oral cancer	Risk factors (tobacco/alcohol/HPV16/betel nut); precancerous lesions (leukoplakia/erythroplakia/OSMF); TNM staging; management
Peptic ulcer	H. pylori (CLO test, triple therapy); NSAID mechanism; complications (perforation/bleeding/stenosis); Billroth I/II
Splenic injuries	AAST grading I-V; non-operative management (grades I-III, haemodynamically stable); splenorrhaphy vs splenectomy; post-splenectomy vaccines (pneumococcal/meningococcal/Hib)

🟢 TIER 3 - Brief Notes Only (1 paragraph each)

For these, just know: definition, one classification, one key investigation, one key management point:

47-Day Compact Theory Schedule

Week	Focus	Topics
Wk 1 (Jun 16-22)	Tier 1 Block A	Shock + Burns + Wound healing + Surgical infections
Wk 2 (Jun 23-29)	Tier 1 Block B	Thyroid + Breast + Hernia
Wk 3 (Jun 30-Jul 6)	GI Block A	Pancreatitis + Biliary + Peritonitis + Peptic ulcer/Ca stomach
Wk 4 (Jul 7-13)	GI Block B + Trauma	Liver + Portal HTN + Splenic/Abdominal injuries + Chest injuries
Wk 5 (Jul 14-20)	Vascular + Colorectal + Misc	DVT/Varicose + Colon cancer + Esophagus + Oral cancer
Wk 6 (Jul 21-27)	Endocrine + Tier 3 sweep	Adrenal + Parathyroid + Pancreatic tumors + all Tier 3 topics (brief notes)
Wk 7 (Jul 28-Aug 2)	Full revision	Rewrite answer plans for all Tier 1; revise tables/scores/classifications

Answer-Writing Tips for Theory

Start every answer with a definition - even one line. It shows structure.
Use classification tables - examiners love them. A table of Duke's staging or shock classes fills space and earns marks efficiently.
Draw simple diagrams - Courvoisier's law setup, Rule of 9s body diagram, triple assessment triangle - these are fast marks.
Write management in steps - Resuscitation → Investigation → Definitive treatment. Use numbered points not paragraphs.
Underline or bold key terms - makes it easy to mark and shows you know the keywords.
Never leave a question blank - write definition + classification + one management point at minimum. Partial credit adds up.
Time management - In a 3-hour paper, LAQs should get 20-25 min each, SAQs 8-10 min each. Practice timing.

Key Tables to Memorise (Pure Marks in Theory)

Ranson's criteria (full table)
Hemorrhagic shock classification (Class I-IV)
Bethesda system for thyroid FNAC (I-VI)
Child-Pugh score (A/B/C)
AAST splenic injury grading (I-V)
Duke's staging colorectal cancer
Fontaine classification (PAD)
Breast cancer TNM staging
GCS (E+V+M components)
Parkland formula + Rule of 9s

These 10 tables alone can account for 20-30% of your theory marks across topics.

You have a clean 47 days and it's theory only - very doable. Prioritise writing practice from Week 3 onwards so you're not just reading but actually able to reproduce structured answers under time pressure. Ask me anytime for a deep-dive on any specific topic.

this is the PYQs

Running Command

Now I have everything - your PYQs, your lecture schedule, and your tutorial list. Let me cross-reference all three and give you the definitive priority list.

Surgery Internals - PYQ-Based Priority Guide

Theory Only | 3rd August 2026 | 47 days

How to Read the PYQs

The "Dhaval" questions = from your college's own previous internal exams (most likely to repeat). The year tags (2023, 2021, 2019...) = university exam questions. Both matter, but Dhaval-tagged questions are your internals PYQs - these are the ones most likely to come again on 3rd August.

🔴 ABSOLUTE TOP PRIORITY

Asked repeatedly in Dhaval internals + matches your current syllabus

1. PANCREATITIS (SU24.1) - Asked almost every year

Exact repeat question:

"Causes, C/F of Acute Pancreatitis, radiological investigations with treatment. Describe Mx of Pseudocyst of Pancreas." Asked: 2021, 2019, 2017, 2015, 2014×2, 2013, 2011, 2009 - this is THE safest bet

Must know:

GET SMASHED mnemonic for causes
Ranson's criteria (full table - 5 on admission + 6 at 48h)
Atlanta classification (mild / moderately severe / severe)
CT severity index (Balthazar grading A-E)
Pseudocyst: definition, Sx, management (wait 6 weeks, then drain - EUS-guided cystogastrostomy)
Pancreatic necrosis: infected vs sterile, role of surgery

2. THYROID (SU22.1-22.4) - Asked every year

Repeat questions:

"Surgical Anatomy of Thyroid, Etiopathogenesis, C/F and Manage THYROTOXICOSIS / SOLITARY THYROID NODULE" Asked: 2017, 2013, 2012 + Multinodular goitre 2015

Must know:

Anatomy: blood supply, recurrent laryngeal nerve, parathyroid relations
Solitary thyroid nodule: triple assessment (clinical + USG + FNAC/Bethesda)
Thyrotoxicosis: Graves vs toxic MNG vs toxic adenoma (table)
Management: antithyroid drugs (carbimazole/PTU) → radioiodine → surgery
Thyroid storm: precipitants, management (Lugol's + PTU + propranolol + steroids)
Short notes likely: Thyroglossal cyst (2014, 2013, 2010, 2009), Primary thyrotoxicosis (2016)

3. BREAST CARCINOMA (SU25.1-25.5) - Asked every year

Repeat question:

"Surgical Anatomy of Breast, Etiopathogenesis, C/F and Manage Early / Advanced Breast Carcinoma in 40yr female" Asked: 2019, 2016, 2014, 2013, 2011

Must know:

Anatomy: quadrants, axillary tail of Spence, lymphatic drainage (axillary levels I/II/III)
Triple assessment
TNM staging (know T1/T2/T3/N0/N1/M0/M1)
Management: WLE + SLNB + radiotherapy vs modified radical mastectomy
Adjuvant therapy: chemotherapy, Tamoxifen (ER+), Herceptin (HER2+), aromatase inhibitors
Short notes: Fibroadenoma, Cystosarcoma phyllodes, Paget's disease of nipple, Peu d'orange

4. HERNIA (SU28.1, AN44.5) - Asked frequently

Repeat questions:

"Inguinal Canal Anatomy" (2017, 2013) + "Define Hernia, Anatomy, C/F of Strangulated Hernia and Management" (2016)

Must know:

Inguinal canal: boundaries (anterior/posterior/floor/roof), contents (male vs female)
Hesselbach's triangle (IPE - Inguinal ligament / inferior ePigastric / rEctus sheath)
Indirect vs direct inguinal hernia (table)
Strangulated vs obstructed hernia (difference table)
Operations: Lichtenstein tension-free mesh, TEP, TAPP
Short notes: Femoral hernia (2015), Sliding hernia/hernia en glissade (2021), Umbilical hernia (2011)

5. SHOCK (SU2.1-2.2) - Standard LAQ

"Define and classify Shock, manage Hypovolemic/Haemorrhagic shock" Asked: 2021, 2015, 2014, 2010

Must know:

Classification: 4 types (hypovolemic/distributive/cardiogenic/obstructive)
ATLS Hemorrhagic shock Classes I-IV (complete table)
Management: ABCDE, 2 large bore IVs, Ringer's lactate / blood products (1:1:1 in massive)
Monitoring: urine output (0.5ml/kg/hr), CVP, MAP >65 mmHg

6. BURNS (SU4.1-4.2) - Standard LAQ

"Define Burn, degree of burns, manage 60%/40% burn in 50kg person" Asked: 2010, 2007 + Escharotomy short note 2021

Must know:

Depth: superficial / superficial partial / deep partial / full thickness (features table)
Wallace Rule of 9s + Lund & Browder (more accurate in children)
Parkland formula: 4 × wt(kg) × %TBSA in first 24h (Ringer's lactate) - half in first 8h
Inhalation injury: signs, management (early intubation)
Escharotomy: when and where
Complications: Curling's ulcer, sepsis, contractures, AKI

7. WOUND HEALING (SU5.1-5.3)

"Define WOUND, TYPES, phases of healing and factors delaying healing" Asked: Dhaval 2021

Must know:

3 phases: inflammatory (0-3d) / proliferative (3d-3wk) / remodelling (3wk-2yr)
Cells at each phase: neutrophils → macrophages → fibroblasts → myofibroblasts
Factors delaying healing: local (infection, ischaemia, foreign body) vs systemic (diabetes, steroids, malnutrition, anaemia)
Keloid vs hypertrophic scar (comparison table - this is a repeated short note)

8. PORTAL HYPERTENSION + UPPER GI BLEED (AN47.11)

"Portal Hypertension, Portosystemic Anastomosis, Management of Acute Variceal Bleeding" Asked: Dhaval, 2021, 2019, 2012

Must know:

Normal portal pressure vs PHT (>12 mmHg)
Pre/intra/post hepatic causes
5 portosystemic anastomotic sites (+ caput medusae / haemorrhoids / oesophageal varices)
Child-Pugh score (A/B/C) - full table
Acute variceal bleed: Terlipressin + IV PPI + endoscopy (banding/sclerotherapy) + antibiotics → Sengstaken-Blakemore tube if refractory → TIPS

🟡 HIGH PRIORITY - Know Well

Topic	Repeat Pattern	Must-Know Points
Acute Pancreatitis / Obstructive Jaundice / CA Pancreas Head	Dhaval 2016	Hepatobiliary anatomy, Courvoisier's law, ERCP, Whipple's procedure
Amoebic Liver Abscess	2023, 2014×2, 2012×2	Anchovy sauce pus, Casoni test vs serology, metronidazole, aspiration indications
Extradural Haematoma	Dhaval, 2019, 2014, 2011, 2007	Middle meningeal artery, lucid interval, lens-shaped CT, burr hole
CA Oesophagus	Dhaval, 2015, 2011, 2009	Squamous (upper/mid) vs adeno (lower/GOJ), staging, McKeown/Ivor Lewis
Acute Cholecystitis / Cholelithiasis	Dhaval, 2011, 2009	Charcot's triad, Murphy's sign, Mirizzi, lap chole, ERCP
Acute Intestinal Obstruction	Dhaval, 2014, 2010, 2009	Causes table, Rigler's triad on AXR, stepladder pattern, management
Varicose Veins + DVT	Dhaval, 2014, 2012, 2009	Trendelenburg test, Virchow's triad, Wells score, LMWH, saphenofemoral ligation
CA Rectum	Dhaval, 2014, 2013	Painless PR bleed, Miles' APR vs AR with TME, LAR, colostomy, TNM
BPH	Dhaval, 2021, 2015, 2014, 2012, 2010	LUTS, PSA, TURP vs alpha blockers, complications
Renal Cell Carcinoma	Dhaval, 2017, 2009	Classic triad (haematuria/loin pain/mass), paraneoplastic features, radical nephrectomy
CA Stomach	Dhaval	Lauren classification, virchow's node, SIS, radical gastrectomy
Spleen Trauma	2023, Dhaval	AAST grading, NOM criteria, post-splenectomy vaccines
Perforated Peptic Ulcer	Dhaval, 2011	Free air under diaphragm on erect CXR, Graham's omental patch

🟢 IMPORTANT SHORT NOTES (very commonly tested)

These come up as 5-mark short notes year after year. Prepare a tight 10-15 line answer with one classification or table each:

Repeated most often:

Torsion testis (2023, 2021, 2015, 2014×2, 2011)
Spinal anaesthesia (2023, 2014, 2013×2, 2012, 2009)
Phimosis (2007, 2016, 2015, 2014, 2013, 2012, 2010)
Appendicular lump / Ochsner-Sherren regimen (2017, 2014, 2012, 2009)
Choledochal cyst (2023, 2019, 2014)
Hydatid cyst (2017)
Child's criteria / Child-Pugh (2017, 2016)
Anal fissure (2021, 2013×2)
Sigmoid volvulus (2017, 2011, 2009)
Pilonidal sinus (2015, 2012, 2007)
Varicocele (2013, 2012, 2010, 2009, 2007)
ICD insertion (Dhaval, 2012×2)
Flail chest (2016, 2011, 2007)
Cardiac tamponade (2012, 2011)
Epidural anaesthesia (2017, 2011, 2010)
Malignant melanoma (2014, 2013, 2010)
TPN + complications (2021, 2012)
Gas gangrene (2021, 2010)
Keloid / hypertrophic scar (2009)
MRCP/ERCP (2021, 2017, 2010, 2007)
Ranson's scoring (Upasana - likely short note)
Pseudocyst pancreas (2011 + Upasana×2)

Revised 47-Day Schedule (PYQ-Driven)

Week	Priority	Topics (most repeated first)
Wk 1 Jun 16-22	Tier 1 Core	Pancreatitis (HIGHEST repeat) + Shock + Burns
Wk 2 Jun 23-29	Tier 1 Core	Thyroid (full: anatomy, MNG, thyrotoxicosis, cancer) + Wound Healing
Wk 3 Jun 30-Jul 6	Tier 1 Core	Breast carcinoma + Hernia (inguinal canal anatomy is a guaranteed question)
Wk 4 Jul 7-13	GI Repeat topics	Portal HTN + Liver abscess + Cholecystitis/Cholelithiasis + CA Oesophagus
Wk 5 Jul 14-20	Trauma + Urology	Extradural haematoma + Chest injuries + Splenic trauma + BPH + RCC
Wk 6 Jul 21-27	Remaining + Short notes	CA Stomach, CA Rectum, IO, Varicose Veins + ALL repeated short notes
Wk 7 Jul 28-Aug 2	Full revision	Rewrite structured answers for top 8 LAQs + revise all short note lists

The Single Most Important Revision Tip

The question "Pancreatitis - causes, C/F, investigations, treatment + Pseudocyst" has been asked in 9 different years. If you only master one LAQ perfectly, make it this one. Write it out fully at least twice before the exam.

Similarly, Inguinal canal anatomy is asked almost every year and is pure marks - it's memorisation, not reasoning. Nail the boundaries, contents (male vs female), and Hesselbach's triangle cold.

Good luck - ask me to write out a model answer for any of these LAQs anytime.

can u make a pdf for the revised 47 day schedule ( PYQ driven ) ?

Reading File

Running Command

Your PDF is ready! Here's the download link:

Surgery 47Day PYQ Plan

PDF Document · PDF

What's inside the PDF:

Color-coded week-by-week plan (each week has its own color theme)
Priority label on every week header (HIGHEST → REVISION)
Detailed bullet points for each topic - exactly what to cover
Short note prep reminders embedded in each week
Theory answer writing formula (7-step structure)
Exam tips section at the end
Must-memorise tables and scores checklist for Week 7

Print it out and stick it somewhere visible. Let me know if you want any changes to the layout or content!

it says thread not found

Running Command

The file exists (17KB). The "thread not found" error is a browser/download issue, not a missing file. Try these options:

Option 1 - Click this direct path:

Surgery 47Day PYQ Plan

PDF Document · PDF

Option 2 - If that still doesn't work, I can convert the full plan into a clean HTML page you can open in your browser and print as PDF using Ctrl+P → Save as PDF. That avoids any download issues entirely.

Option 3 - I can re-generate the same content as a simpler single-page PDF that might download more reliably.

Which would you prefer?

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