What's inside

Q1 — Bariatric/Metabolic Surgery (30 marks)

• Definition + NIH indications table (BMI criteria, T2DM thresholds)
• Mechanisms diagram (restriction vs. malabsorption vs. gut hormone changes)
• All 5 major procedures with schemas: LSG, LRYGB, LAGB, BPD-DS, Mini Gastric Bypass
• Comparison table (EWL%, T2DM remission, key risks)
• Pre-op workup, post-op complications table, nutritional supplementation protocol
• Recent trends: OAGB, SADI-S, robotic bariatrics, STAMPEDE trial, endoscopic therapies

Q2 — Carcinoma Oesophagus (30 marks)

• Epidemiology + SCC vs. AC comparison table (geography, precursor, trend)
• Full aetiology (ALDH2 deficiency, Barrett's sequence, Plummer-Vinson, tylosis)
• Barrett's → AC progression diagram
• TNM 8th Ed. staging table + spread pathways
• Clinical features table (dysphagia → cachexia)
• Investigations algorithm: OGD → CT → EUS → PET-CT → Laparoscopy
• Surgery: Ivor Lewis, McKeown, Transhiatal, MIO approaches with indications
• Reconstruction options (gastric conduit, colonic interposition, jejunal)
• Neoadjuvant therapy: CROSS trial, FLOT regimen
• Palliative management table (SEMS, chemo, immunotherapy, fistula management)
• Siewert classification note, 5-year survival figures

Q3 — TPN (10 marks)

• Indications + composition table (7 components with doses)
• Central vs. peripheral access; CXR confirmation
• Complications table (insertion, line, metabolic — 10 complications)
• Monitoring protocol diagram (daily/weekly/monthly)
• Refeeding syndrome: mechanism, risk factors, management

Q4 — Blood Transfusion (10 marks)

• Blood products table: PRBC, FFP, platelets, cryoprecipitate, PCC, albumin
• Single transfusion complications (HAEMOLYTIC reaction, FNHTR, TRALI, infections with risk figures)
• Massive transfusion complications table: coagulopathy, hypoCa, hyperK, hypothermia, TACO
• Immediate management flowchart
• Blood substitutes (HBOCs, PFCs — current status)
• Blood conservation strategies + CRASH-2 trial, TRICC trial

Q5 — Robotic Surgery (10 marks)

• History timeline table (PUMA 1985 → da Vinci → Hugo/Versius 2023)
• Component diagram: Surgeon console / Patient-side cart / Vision tower
• Types: Teleoperated, Active, Semi-active, AI-assisted
• Advantages: 7° freedom, tremor suppression, motion scaling, 3D HD vision, ergonomics
• Disadvantages: Cost (figures), no haptic feedback, ROLARR trial result
• Applications table across all specialties (TORS, RARP, TME, HPB, bariatrics)
• Future: AR overlay, STAR autonomous robot (Science Robotics 2022), 5G telesurgery

Contents summary

Q1 — Bile Duct Injuries at Cholecystectomy (30 marks)

• Aetiology/risk factors table; Bismuth I–V classification + diagram; Strasberg A–E5 classification; Stewart-Way classification
• Clinical presentation by timing (intraop → early → late)
• CVS (Critical View of Safety) — 3 criteria explained; IOC, ICG fluorescence
• Management table by injury type; Roux-en-Y hepaticojejunostomy diagram + principles
• Timing of repair; complications (secondary biliary cirrhosis, portal hypertension)

Q2 — Surgical Anatomy of Biliary Tract + Jaundice (30 marks)

• Intrahepatic/extrahepatic biliary anatomy; CBD relations (supraduodenal, retroduodenal, intrapancreatic); Calot's triangle contents
• Extrahepatic anatomy diagram (hepatic ducts → CBD → ampulla of Vater)
• Classification of jaundice (pre-hepatic / hepatic / obstructive) with mechanism table
• Differential diagnosis of obstructive jaundice (7 causes with distinguishing features)
• LFT interpretation table (pre-hepatic vs. hepatocellular vs. obstructive)
• Imaging investigations: USS → MRCP → CT → ERCP → PTC → EUS
• Pre-operative management of obstructive jaundice (Pye's protocol: Vit K, mannitol, antibiotics); Courvoisier's Law

Q3 — Renal/Ureteric Calculi (30 marks)

• Stone types table (calcium oxalate, struvite, uric acid, cystine) with radio-opacity
• Pathogenesis diagram (supersaturation → nucleation → crystal growth; Randall's plaques)
• ESWL: mechanism, best indications, contraindications, steinstrasse
• URS + Holmium laser: stone-free rates, flexible vs. semi-rigid
• PCNL: Indications (>2 cm, staghorn), mini/micro-PCNL, complications (haemorrhage)
• Treatment comparison table; staghorn management; infected obstruction emergency protocol
• Metabolic evaluation + prevention; thulium fibre laser (latest advance)

Q4 — Carcinoma Prostate (30 marks)

• McNeal's zonal anatomy table; surgical relations; Walsh's neurovascular bundles
• Gleason grading (Grade Groups 1–5); osteoblastic bone metastases
• TNM 8th Ed. full staging table; D'Amico risk classification
• Investigations: PSA (density, velocity, free:total), mpMRI PI-RADS, PSMA-PET CT
• Management by risk group: Active surveillance (ProtecT trial), RARP, EBRT+brachytherapy, ADT
• Treatment summary table; VISION trial (177Lu-PSMA-617, 2021); STAMPEDE trial

Q5 — Extradural Haematoma (10 marks)

• MMA anatomy; lentiform/biconvex shape explained
• Monroe-Kellie doctrine diagram → lucid interval → Hutchinson pupil → Cushing's triad
• CT findings; surgical criteria table (>30 mL, >15 mm, midline shift >5 mm)
• Craniotomy; emergency burr hole; prognosis (excellent if promptly treated, mortality <5%)

Q6 — Carcinoma Urinary Bladder (10 marks)

• Types (TCC 90%, SCC, adenocarcinoma); aetiology table (smoking, aniline dyes, schistosomiasis, cyclophosphamide)
• Molecular pathways diagram (FGFR3 low-grade vs. TP53/RB1 high-grade)
• TNM staging table; NMIBC vs. MIBC distinction
• TURBT + intravesical BCG (CIS/high-grade); urinary diversions (ileal conduit, Studer neobladder)
• Neoadjuvant MVAC/GC; EV-302 trial (enfortumab vedotin + pembrolizumab, 2024)