Final MBBS General Surgery - LAQ Bank (15 Marks) - Unit Wise

Paper format reminder (NMC CBME): Paper I = 100 marks (General Surgery 100%). Paper II = 100 marks (General Surgery 40%, Orthopaedics 40%, Anaesthesia 10%, Radiodiagnosis 10%). LAQs are typically 15 marks each.

PAPER I - GENERAL SURGERY

UNIT 1: Surgical Pathology / Basic Surgery

1. Describe the pathophysiology, clinical features, and management of Surgical Shock. Add a note on septic shock.
2. Discuss the types of wounds and wound healing - phases, factors affecting healing, and complications.
3. Describe the pathophysiology and management of Burns - calculate TBSA, fluid resuscitation (Parkland formula), complications.
4. Blood transfusion - indications, types, hazards, and management of transfusion reactions.
5. Write about surgical infections - Clostridial infections (gas gangrene), necrotizing fasciitis - features and management.
6. Discuss surgical nutrition - malnutrition in surgical patients, enteral vs parenteral nutrition, indications.
7. Describe preoperative and postoperative care of a surgical patient - assessment, preparation, complications.
8. Write about fluid and electrolyte balance in surgical patients - hyponatremia, hypokalemia, metabolic acidosis.
9. Discuss principles of tumour surgery - TNM staging, types of resection, oncological principles.

UNIT 2: Abdomen - Acute Abdomen & Peritoneum

1. Define acute abdomen. Describe the causes, clinical features, investigations, and management of Peritonitis (generalized/perforative).
2. Discuss the etiopathogenesis, clinical features, and management of Acute Pancreatitis. Mention Ranson's criteria and Atlanta classification.
3. Write about the clinical features, investigations, and management of Perforated Peptic Ulcer with a note on operative steps.
4. Describe Acute Appendicitis - pathology, clinical features (Alvarado score), investigations, differential diagnosis, and management.
5. Classify and discuss the management of Intestinal Obstruction - mechanical vs paralytic, simple vs strangulated.
6. Write about Volvulus of Sigmoid Colon - clinical features, x-ray findings, and management (Omega/Coffee bean sign).

UNIT 3: Hernia

1. Define hernia. Classify inguinal hernias. Describe the anatomy, clinical features, and operative management (Lichtenstein/laparoscopic) of Inguinal Hernia.
2. Discuss femoral hernia - anatomy of femoral canal, clinical features, differential diagnosis from inguinal hernia, and operative management.
3. Write about complications of hernia - reducible, irreducible, obstructed, strangulated - pathology and management of strangulated hernia.
4. Discuss Umbilical and Paraumbilical hernia - types, differences, operative repair.
5. Write about Incisional hernia - causes, prevention, management (mesh repair).

UNIT 4: GI Surgery - Oesophagus, Stomach, Duodenum

1. Classify carcinoma of oesophagus - staging, clinical features, investigations, and surgical management (Ivor-Lewis / transhiatal oesophagectomy).
2. Discuss Peptic Ulcer Disease - pathophysiology (role of H. pylori), complications, and surgical management (partial gastrectomy, vagotomy).
3. Describe the clinical features, investigations, and management of Carcinoma Stomach - add a note on types and surgical resection.
4. Write about Gastro-oesophageal Reflux Disease (GERD) and Hiatus Hernia - types, clinical features, and management (Nissen fundoplication).
5. Discuss Upper GI Bleeding - causes, initial resuscitation, endoscopic management, and surgical options.

UNIT 5: GI Surgery - Small & Large Bowel, Rectum, Anal Canal

1. Discuss Carcinoma Colon - predisposing factors, clinical features (right vs left), staging, and surgical management (right/left hemicolectomy).
2. Write about Carcinoma Rectum - staging, clinical features, sphincter-preserving vs abdominoperineal resection (APR), and adjuvant therapy.
3. Describe Inflammatory Bowel Disease - differentiate Crohn's disease from ulcerative colitis; indications and types of surgery.
4. Discuss the pathology, clinical features, and management of Haemorrhoids (Piles) - grades and treatment (rubber band ligation, haemorrhoidectomy).
5. Write about Anal Fissure, Fistula-in-Ano, and Anorectal Abscess - classification, clinical features, and operative management (Parks' classification).
6. Discuss Hirschsprung's Disease - pathology, clinical features, diagnosis, and surgical management (Swenson's pull-through).

UNIT 6: Liver, Biliary Tract & Pancreas

1. Describe the aetiology, clinical features, investigations, and management of Obstructive Jaundice - differentiate from hepatic and pre-hepatic jaundice.
2. Classify and discuss the management of Gall Stones (Cholelithiasis) - composition, clinical presentations (biliary colic, acute cholecystitis, CBD stones), laparoscopic cholecystectomy.
3. Write about Acute Cholecystitis - pathology, clinical features, Charcot's triad, and management.
4. Discuss Carcinoma of the Pancreas (head) - clinical features (Courvoisier's sign), investigations, Whipple's procedure.
5. Write about Chronic Pancreatitis - aetiology, clinical features, complications, and surgical management.
6. Discuss Portal Hypertension - causes, pathophysiology, clinical features (variceal bleeding), and management (TIPS, devascularization).
7. Write about Liver Abscess - amoebc vs pyogenic - clinical features, investigations, and treatment.

UNIT 7: Breast

1. Classify Carcinoma Breast - risk factors, clinical features, spread, investigations (FNAC, mammography), staging, and treatment (BCS vs mastectomy + axillary clearance + adjuvant).
2. Discuss the clinical features and management of Fibroadenoma and Fibrocystic Disease of breast.
3. Write about Paget's disease of nipple and nipple discharge - causes, investigations, management.
4. Describe Mastitis and Breast Abscess - acute and chronic (TB), management.

UNIT 8: Thyroid & Parathyroid

1. Classify Thyroid Swelling (Goitre) - investigations (TFTs, USG, FNAC, isotope scan) and management of euthyroid multinodular goitre.
2. Discuss Carcinoma Thyroid - types (papillary, follicular, medullary, anaplastic), clinical features, staging, and surgical management (total thyroidectomy).
3. Write about Grave's Disease (Primary Hyperthyroidism) - pathogenesis, clinical features, medical, radioiodine, and surgical management.
4. Discuss complications of thyroidectomy - RLN injury, hypoparathyroidism, thyroid storm, and their management.
5. Write about Hyperparathyroidism - primary, secondary, tertiary - clinical features, investigations, and management.

UNIT 9: Neck Swellings, Salivary Glands & Face

1. Discuss the differential diagnosis and investigation of a Midline neck swelling (thyroglossal cyst, thyroid, dermoid).
2. Write about Lateral neck swelling - branchial cyst, cystic hygroma, cervical lymph node enlargement - features and management.
3. Discuss Parotid gland tumours - Pleomorphic adenoma, Warthin's tumour, malignant tumours - clinical features and management.
4. Write about Submandibular Salivary Gland calculi - clinical features and management.

UNIT 10: Peripheral Vascular Surgery & Lymphatics

1. Classify Varicose Veins - clinical features, investigations (Trendelenburg, Perthe's, Tourniquet tests, Doppler), and management (EVLA, surgery - Trendelenburg operation + stripping).
2. Discuss Deep Vein Thrombosis (DVT) - pathogenesis (Virchow's triad), clinical features, diagnosis (Doppler, D-dimer), prevention, and treatment.
3. Write about Arterial occlusive disease - Peripheral arterial disease (PAD), Buerger's disease - features and management (embolectomy, bypass).
4. Discuss Lymphoedema - primary vs secondary, clinical features, investigations, and management.
5. Write about Aortic Aneurysm - types, clinical features, complications, and management (EVAR vs open repair).
6. Discuss Pulmonary Embolism - pathogenesis, clinical features, investigations, and management.

UNIT 11: Urology

1. Classify Renal Calculi (Urolithiasis) - clinical features, investigations (KUB, IVP, CT), and management (ESWL, PCNL, ureteroscopy).
2. Discuss Benign Prostatic Hyperplasia (BPH) - pathology, LUTS, investigations (PSA, uroflowmetry), and management (TURP).
3. Write about Carcinoma Bladder - risk factors, clinical features, staging, and management (TURBT, cystectomy, intravesical therapy).
4. Discuss Carcinoma Prostate - clinical features, PSA, staging, and management (radical prostatectomy, hormonal, radiotherapy).
5. Write about Hydronephrosis - causes, clinical features, investigations, and management.
6. Discuss Ectopic testis and testicular torsion - clinical features, management (orchidopexy, Doppler).

UNIT 12: Neurosurgery (Basic)

1. Discuss Extradural Haematoma (EDH) - mechanism, "lucid interval", CT findings, and management.
2. Write about Raised Intracranial Pressure (RICP) - causes, clinical features, Cushing's triad, and management.
3. Discuss Subdural Haematoma - acute vs chronic - features and management.

PAPER II - SURGERY ALLIED

UNIT 13: Orthopaedics

1. Describe the clinical features, investigations, and management of Fracture Neck of Femur - Garden's classification, complications (AVN), and surgical management (hemiarthroplasty, THR).
2. Discuss Colles' Fracture - mechanism, clinical features (dinner fork deformity), treatment, and complications.
3. Write about Fracture Spine (Cervical / Thoracolumbar) - classification, management (immobilization, surgical stabilization), complications (cord injury - ASIA grading).
4. Discuss Osteosarcoma and Ewing's Sarcoma - clinical features, radiology, staging, and management.
5. Write about Osteoarthritis of Hip and Knee - clinical features, investigations, and management (THR, TKR).
6. Discuss Septic Arthritis and Osteomyelitis (Acute / Chronic) - pathology, clinical features, and management.
7. Write about Dislocations of Hip - anterior vs posterior - features, management, AVN complication.
8. Discuss Carpal Tunnel Syndrome - anatomy, features, diagnosis (nerve conduction), and management.
9. Write about Congenital Talipes Equinovarus (CTEV/Club Foot) - classification, and management (Ponseti method).
10. Discuss Intervertebral Disc Prolapse (IVDP) - lumbar / cervical - features, investigations (MRI), and management (conservative, microdiscectomy).

UNIT 14: Anaesthesia (10 marks paper - but LAQ still relevant)

1. Discuss General Anaesthesia - stages, agents used (inhalational and IV), complications.
2. Write about Spinal (Subarachnoid Block) and Epidural Anaesthesia - technique, advantages, complications.
3. Discuss Airway management - RSI, laryngoscopy, intubation, difficult airway algorithm.
4. Write about Complications of anaesthesia - malignant hyperthermia, aspiration pneumonitis (Mendelson's syndrome), awareness under GA.

UNIT 15: Radiodiagnosis (10 marks paper)

1. Discuss the role of Imaging in Acute Abdomen - plain X-ray findings (free gas, obstruction patterns), CT abdomen.
2. Write about USG abdomen - indications, technique, findings in gallstones, appendicitis, renal calculi.
3. Discuss CT scan vs MRI - principles, indications, advantages, and limitations in surgical patients.
4. Write about Interventional Radiology - FNAC, drainage of abscess, TIPS, angioplasty - indications and role.

High-Frequency Repeat Topics Across Universities (Star Topics)

Tips for 15-mark LAQ Answers

1. Definition / Introduction (2-3 lines)
2. Classification / Aetiology (table or list)
3. Pathology / Pathophysiology (short)
4. Clinical Features (symptoms + signs)
5. Investigations (lab + imaging)
6. Management (medical + surgical - this gets maximum marks)
7. Complications (short)
8. Prognosis (1-2 lines if applicable)