Past Question Papers

Dr Dominic Mathew
Paper 1
Basic Sciences
Nutrition and immunity, Inflammation and sepsis
1. Vitamin B 12: dietary sources, absorption, tests for malabsorption D14
2. Gi immune system: secretary IgA- draw, peyer's patches D14
3. Perioperative assessment of nutrition and the pros & cons of parenteral nutrition in the G.I. surgical patient. D15 Discuss the
indications and complications of parenteral nutrition in GI surgical patients D11 Complications, its management J19
4. Describe the principle of enteral nutrition, types of enteral diets and advantages over parenteral
nutrition D11
Inflammation, Sepsis, Shock
1. Inflammatory mediators of acute inflammation D17
2. Hemorrhagic shock D19
3. a) Management of septic shock b) ARDS J19
4. Describe the importance of gram negative sepsis in surgical intensive care units and the preventive measures for gram negative
sepsis J18
5. What is the Surviving Sepsis Campaign? b) What is Care bundle in critical care? How can these be used to improve outcome in a
critical care unit after a gastrointestinal surgical procedure D16
6.
Preoperative antibiotics, Care
1. Describe the role and practice of prophylactic antibiotics in G.I. surgery D11

2. Basis and selection criteria for antibiotic prophylaxis. Discuss multidrug resistant bacteria J19
3. Evaluation and impact of sarcopenia in GI cancers D19
4. Prehabilitation D19
Audit, Theatre Safety
1. Importance of medical record Keeping and audit
2. Surgical safety checklist. What are its implications in quality and safety J18
3. Discuss the principle of WHO surgical safety checklist D12
4. One of your health care workers accidentally gets a needle stick injury from a Hepatitis B
positive patient. How will you manage? How do you prevent such injuries?
5. How will you manage a needle stick injury to healthcare personnel during a right hepatectomy in a
patient with hepatitis B virus infection? J17
Postoperative care - General
1. What is the Clavien-Dindo method for grading complications after gastrointestinal surgery? What are its benefits and
drawbacks? List two possible improvements to this method. D16
2. How do you classifiy surgical complications. What is the importance of classification. What is benchmarking as an outcome
parameter in surgical practice and its importance D19
3. Enumerate various causes of paralytic ileus and describe its pathophysiology D12
4. Write short notes on Enhanced recovery after surgery (ERAS) protocols in G.I. surgical patients. Its pros and cons. D15 In the
Context of Colorectal D18
5. Abdominal Compartment Syndrome
Pain
1. Compare 2 different types of pain - visceral and somatic- types of fibres,
clinical characteristics, precipitating stimuli D14
2. SN on pain controlled Analgesia D13
Energy Sources, Devices, newer modality of treatment
1. SN on energy sources in GI surgery D13
2. Current status of Robotic surgery in GI surgery D15 D14
3. Describe the techniques of Robotic surgery, describe the current status J18
4. Advantage and disadvantage of robotic GI D11
5. Rapid infusion pump D17
6. Hyperbaric oxygenation D17
7. What are stem celts? Discuss the role of stem cells in Gastro intestinal diseases J19
8. Microbiome Medicine J19
9.
Principles of oncology
1. Role of liquid biopsy in GI cancer D19
2. ECOG J18
3. Describe the adenoma - CArcinoma sequence in detail. Discuss the role of
specific genes at its different points. How does it plays its role in disease
control D13
4. What do you understand by Micrometastases. Discuss the status in Gastric
and gall bladder Malignancy D11Methdology for detection, status in GI
maliganancy D15
5. Describe the evidence based role of neoadjuvant treatment in various cancers affecting G.I. tract D12
General Concepts of Imaging in GI surgery
1. Discuss the role of contrast enhanced ultrasound imaging in abdominal masses. numerate its Indications and limitations.
2. Discuss the role of endoscopic ultrasound in the evaluation of various conditions in G.l. surgery D12.
3. Describe the various functional imaging techniques of G.I tract and their importance in the evaluation of
various disorders D12
4. Role of Diffusion-weighted MRI and Secretin-stimulated MRI in the evaluation of GI disorders D16.

5. Role of flouresecent imaging in GI surgery

Statistics
 Statistics
1. What is sensitivity, specificity, positive and negative prediction values of a test? How are they calculated? D11
2. What are sensitivity, specificity, negative predictive value and positive predictivevalue of a diagnostic investigation? D15 ...and
diagnostic accuracy in the context of PET in CA Gb D18
3. Design of a study to compare a new test for the diagnosis of ulcerative colitis with the present ‘gold standard’ method J17
4. What are P-values, confidence intervals, odds ratios and levels of evidence? D14
5. What do the terms - odds ratio, hazard ratio, relative risk, absolute risk and confidence interval mean and where are these used? D16
6. Null Hypothesis D17
7. Chi Square Test D17
8. What are study designs and discuss about meta-analysis? J19
9. Impact Factor D17
Sampling, Randomization, RCT
1. Describe the methodology of sampling in clinical study population J18
2. In the context of a randomized controlled trial, what do the terms random sequence generation, allocation concealment,
blinding, sample size and outcome assessment mean ? What is the purpose of trial registration? D16
3. What is randomization? What are various methods/tools of randomization in clinical medicine? What are the benefits of
randomization? D13
4. Randomized control trials- Define and give examples in GI surgery D17

5. Key elements of a randomized controlled trial b) How is blinding different from allocation concealment? c) What do
you understand by post hoc analysis? D18
6. Ethical concerns in randomizing patients to two different modalities of treatment to assess the efficacy of the therapy for the
treatment of a life threatening conditions
Esophagus
Anatomy
1. Describe surgical anatomy of the esophagus. Describe resections based on anatomy of esophagus.

2. Discuss the development of foregut b) Anatomy of the omentum J18

Tracheoesophgeal fistula
1. Tracheoesophgeal fistula D17
Motility Disorders
1. Classify esophageal motility disorders. How will you evaluate such a patient? D 16 D13

2. Discuss the esophageal motility disorders and mention the investigations in motility disorders of esophagus J18

3. Nutcracker Esophagus D17

Achalasia Cardia
1. Achasia Cardia - pathogenesis, manometry, radiology D14
2. High resolution manometry Describe. Classift achalsia cardia based on HRM and its clinical relevance D19
3. Enumerate the investigations for Achalasia cardia. Discuss various options in management. How will you
manage a 17 yr. old patient presenting with Achalasia cardia? D17
4. POEM in Achalsia Cardia D13 D15 J17 J19
5. Critically analyses: “Achalasia cardia is best treated by pneumatic dilatation” D15
6. Discuss the options to prevent Gastroesophageal reflux during surgery for Achalasia Cardia.
7. Describe in detail the laparoscopic surgical treatment of achalasia cardia and critically evaluate the
surgical treatment with non-surgical modalities of treatment D12
8. Evaluation and management of a patient with mega-esophagus J17
9. Define the sigmoid esophagus in achalasia cardia. Discuss the surgical options J19
Esophageal Perforation
1. What are the causes of esophageal perforation? Outline the management of a patient with esophageal
perforation D11
2. Enumerate the causes of esophageal perforation What are the management options for a patient presenting 48
hours after perforation? J19
3. What is boerhaave's syndrome Outline treatment options in a patient based on timing of presentation D19

.
Diverticulum
1. Zenker’s diverticulum: Clinical presentations, evaluation and management D15
Barrett’s Esophagus
1. Define Barrett’s esophagus. Discuss its etiopathogenesis and describe its histopathology D11
2. Management of patient with Barrett’s esophagus with high grade dysplasia.
Malignancy
1. How will you evaluate a patient with upper esophageal malignancy? Outline the management options
for mid-esophageal adenocarcinoma D16 D17
2. Discuss the evaluation and principles of management of a patient with squamous cell carcinoma of the
lower third of the esophagus D12
3. Neo-adjuvant therapy in carcinoma esophagus

4. a) Indications and contraindications for neoadjuvant chemoradiotherapy in a patient with esophageal

carcinoma) How will you assess such a patient after completion of therapy?
5. Discuss the role of Neoadjuvant treatment in esophageal carcinoma. J18 Discuss some of the
published trials in this regard D13
Malignancy - Surgery
1. Compare the risks and benefits of trans-thoracic vs trans-hiatal esophageal resection in a middle third
esophageal carcinoma D16

2. Compare and contrast Laparoscopic esophagectomy vs robotic esophagectomy in carcinoma esophagus D19
3. Current status of radical lymphadenectomy in esophageal cancer.
4. List the possible advantages of a robotic esophagectomy in esophageal cancer D18

5. How will you choose an organ for esophageal replacement after esophagectomy? What are the advantages
or disadvantages of free Jejunal graft over colon?
6. Lymphatic drainage of the esophagus and the rationale for 3- field lymphadenectomy for esophageal
cancer D15
7.
8. Discuss the pros and cons of 3 field lymphadenectomy D17
9. Components of 2-field and 3-field esophagectomy.Their present role in the management of carcinoma esophagus J17
10. Discuss 2-field vs 3-field lymphadenectomy in a patient with squamous cell cancer of the middle third of the
esophagus. D18
11. Discuss pros and cons of three-field lymphadenectomy in the management of esophageal
malignancy.
Corrosive Injuries
1. Management of patient with corrosive ingestion 6 hrs. Ago.
2. Evaluation and management of suspected necrosis of the esophagus following corrosive ingestion in a
patient presenting in the emergency 12 hours later. J17
3. A 16 year old girl attempted suicide by ingesting a toilet cleaner 6 months ago. She presents to you with
a feeding jejunostomy in place. Discuss the evaluation of this patient. Based on the evaluation, what are
the different surgical options available? Describe the pros and cons of the various surgical procedures
D13
4. What are various esophageal substitutes for corrosive injury of the esophagus? Describe the
selection criteria of the individual substitute keeping the advantages and disadvantages of each
substitute in mind J19
5. Anatomy of the colon in relation to its use as a replacement organ after esophagectomy with emphasis on
the vascular supply.D17
6. How will you investigate and treat a 22 year old female with TEF following
corrosive injury D19
7. Define a high pharyngo - esophageal corrosive stricture Discuss various
management options D19 Evaluation and management of corrosive pharyngeal stricture J18
Complications
1. Enumerate the causes of tracheoesophageal fistula D17
2. Chylothorax D17
3. Anatomy of the thoracic duct and outline management of a patient with post esophagectomy
leak from thoracic duct. J17 D15
GERD
1. GERD and H pylori: discuss the relationship D14
2. Evaluation and surgical management of gastroesophageal reflux disease D18
Stomach
Anatomy
1. Describe Lymphatic drainage of stomach. Describe D2 Gastrectomy for an antral lesion.
2. Lymphatic drainage of the stomach.
3. Lymphatic stations of stomach D16
Physiology
1. Gastric function tests D17
Benign Disorders
1. Hypertrophic pyloric stenosis D17
2. Gastric Volvulus and its management D17
GIST
1. Write a short note on multimodality treatment on Gastro Intestinal StromalTumor (GIST) with special
emphasis on impact on outcome.
2. Describe in detail the molecular basis of gastrointestinal stromal tumors D12
3. Role of immunohistochemistry (IHC) in Gastrointestinal stromal tumour D13
4. What is GIST? Management of gastric GIST J18.
5. Evaluation and management of a patient with 8 cm size gastrointestinal stromal tumour J17
6. Evaluation and management of an incidentally detected asymptomatic GIST in the fundus of stomach, lsit teh indications for
adjuvant therapy in such tumors D16
7. a) Evaluation and management of an incidentally detected, asymptomatic gastrointestinal stromal tumour (GIST) in the fundus
of the stomach b) List the indications for adjuvant therapy in such tumors.
Lymphoma
1. Discuss the evaluation and management of a patient with a gastric lymphoma. Enumerate the role of surgery
in such a patient D13
Carcinoma GEJ
1. How will you investigate and manage Siewert Type Il carcinoma of gastroesophageal junction? J19
2. Siewert’s classification and its role in the management of patients with gastro- esophageal junction
tumors D15
Carcinoma Stomach
1. H pylori infection and gastric cancer J19
2. Describe the staging system for and techniques for determining the stage of disease in patients with
carcinoma stomach
3. Staging of cancer stomach and the changes in the AJCC 8th edition compared to the 7th edition D18
4. What do you understand by micro-metastasis? Discuss the status in gastric and gall bladder
malignancy D 11
5. Role of neoadjuvant chemotherapy / chemoradiotherapy in management of carcinoma stomach. Give and evidence
based approach D19
6. Draw a diagram to illustrate the position of various lymph node stations in relation to D2 gastrectomy for carcinoma stomach
D16
7. D2 Gastrectomy. D17

8. Describe station based lymphadenectomy in carcinoma stomach J18

9. Total gastrectomy J18 Indications Method(s) of reconstruction in total gastrectomy. J17

Complications of surgery
1. What are the etiopathogenesis of delayed gastric emptying? Discuss the management
2. Management approach of a patient with post D2 gastrectomy duodenal stump blow out D18 leak D15
3. Classify postgastrectomy complications. How will you investigate and manage pt with duodenal stump blowout after
subtotal gastrectomy D19
4. How would you assess and manage a duodenal stump ‘blow out’ after a BILLROTH II gastrectomy for a giant duodenal
ulcer? D16
5. What is Roux Stasis syndrome, discuss its management D18
GI BLEEDING
Bleed
1. Define and classify obscure GI bleed. How will you investigate a 33 yr old male presenting with obscure GI bleed
D19
2. Upper GI bleeding. Causes. algorithm for evaluation and resuscitation D11. Indications of surgical intervention D16
3. Evaluation and management of a patient with massive upper gastrointestinal bleeding D11 D18
4. Outline the management approach of a patient with lower gastrointestinal bleeding D15
5. Describe the approach to massive lower gastrointestinal hemorrhage in an algorithmic manner D12
Bariatric Surgery
 1. Describe principles, various methods & limitations of restrictive surgery for morbid obesity.
2. Define and classify morbid obesity. Discuss management options for a 40 yr old female with BMI of 50 along with DM D19
3. What is morbid obesity? What are the indications and surgical options in these patients? Discuss the pros
and cons of different surgical procedures J17, D13
4. Selection of a bariatric surgical procedure based on BMI. What are Long term complications of bariatric surgery. D18
5. Bypass surgery vs Sleeve gastrectomy for morbid obesity J19
6. Critically evaluate the role of bariatric surgery in the treatment of type II diabetes mellitus D12
7. Workup for a patient for bariatric surgery.

8. Indications for bariatric surgery and technique of sleeve gastrectomy J18

9. Describe the indications of Sleeve gastrectomy. Discuss in brief the complications and their management of Sleeve gastrectomy
D17
10. Post weight loss body contouring after bariatric surgery D17
Duodenum
Trauma
1. A patient of Road Traffic Accident (RTA) was brought to the Emergency and after evaluation found to have D2 and D3 laceration
with transection of pancreatic neck. Describe the management strategy. D17
2. Describe the mechanism of duodenal injury. How will you manage a patient with penetrating duodenal injury to the 2ND part of
duodenum ?
3. Discuss management of pancreatoduodenal Trauma J 18
Small Bowel
Small Bowel Evaluation

1. What is Enteroclysis? Discuss its indications D11

2. What is Capsule endoscopy, How does it work, what are its uses and
limitations J18, D17

3. Describe techniques of small bowel endoscopy. Mention its indications & limitations.
4. Describe the various endoscopic and imaging methods of evaluating the small intestine D12
TB
1. Role of non radiological tests in Koch’s Abdomen D13
2. Outline the diagnosis and management of a patient with abdominal tuberculosis D18
3. What are the symptoms signs and management of a patient with abdominal cocoon D16
Mesenteric Ischemia
1. Write Short Notes on Causes of MI
2. Causes of acute MI, describe management of pt with acute Superior
Mesenteric vein thrombosis
3. Causes and management of chronic mesenteric ischemia D19
Diverticula, Fistula, tumors
1. Discuss the presentation and management of small bowel diverticular disease D11J18
2. How will you evaluate a patient with suspected small bowel diverticula? Outline the management of such a
patient J17
3. What is succus entericus? Briefly mention the fluid and electrolyte losses from proximal jejunal! Fistula. D13
4. Outline the principles and management of small bowel fistula D14
5. Radiation enteritis D19
6. Small bowel carcinoids D19
GI lymphoma
1. Clinical presentation, evaluation and treatment approach D15
Surgery
1. Delayed Small Bowel Anastamosis
Short Bowel, Transplant
1. What is Short Gut Syndrome? Discuss its management. D11 J18

2. Indications and complications of small bowel transplant

3. Indications for small bowel transplant, discuss present results- short term,
long term J17
Paper 2
Ascites and peritoneum
1. Write short note on abdominal compartment syndrome D13

2. What is refractory ascites? Discuss briefly surgical options for its management.

3. What is refractory ascites? Outline its management D11

4. What is pseudomyxoma peritonei? Discuss its causes and management D14

5. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei D16
6. Peritonectomy J18
Spleen
1. Splenic abscess
2. SN on Prophylactic immunoprotection before spleenectomy D13
Portal Hypertension
Portal Hypertension
● Role of surgery in a patient with variceal bleeding due to portal hypertension
D18
● Enumerate the devascularization procedure that can be done for a patient
with varcieal bleeding. What are the results of these patients in cirrhotic and
non cirrhotic pateints when done for acute variceeal bleeding J17
● What is portal hypertensive gastropathy? How is it diagnosed and graded? What are the implications of its presence in the

management of patients with portal hypertension? D15

● Ectopic varices
 Shunt Surgery
1. What are SELECTIVE SHUNTS. Discuss rex shunt J19
2. Short diameter interposition portocaval shunt D13

3. Sarfeh shunt D17

4. Make Shift Shunts J18
5. What are nonselective shunts
6. What is a nonselective shunt, give 2 examples. Discuss the role of shunt surgery in PHTN in present era D19
Portal Biliopathy
1. What is portal biliopathy? Describe the findings of portal biliopathy on USG and MRC D13

2. Diagnosis and management of a patient with asymptomatic portal cavernoma cholangiopathy in a

patient with extra hepatic portal venous obstruction D16
3. Evaluation and management of a patient of Portal biliopathy, who Presented with recurrent cholangitis D17
Liver
Anatomy
1. Describe the hepatic venous anatomy and the role of middle hepatic vein in living donor liver
transplantation. D12
2. Discuss Segmental anatomy of liver and its interpretation on CT imaging J18

3. Anatomy of the caudate lobe of the liver as relevant to the excision of a caudate lobe tumour. J17

4. Couinaud’s segmental anatomy of the liver-Diagrammatic representation.b. Glissonian approach to liver resection D16

5. Anatomy of the hepatic artery and its common variations. b) Injury to the right hepatic artery may not result in ischemia
 Budd Chiari Syndrome
1. What is Budd Chiari syndrome? Discuss its management D11
2. Evaluation and management of a patient with hepatic venous outflow tract obstruction J17
 Acute liver failure
1. Thromboelastogram D17
2. Define acute liver failure. Enumerate its causes. Describe the indications, of liver transplantation in
acute liver failure.
3. What are the various Liver Support Systems? Highlight the importance and use of Bio- artificial
Liver(BAL). D11
4. Role of MARS in acute liver failure D17

5. Liver dialysis D13

6. Liver regeneration D13

 Future liver remnant
1.Discuss the assessment of FLR in a patient of chronic liver disease needing right hepatectomy. Discuss the role of salvage transplant
D17.
2.How will you assess the future liver remnant in a patient requiring an extended right hepatectomy for colorectal liver metastasis? b)
What are the options to increase the future liver remnant? J17
3.Why is the FLR important ? discuss the options available when the FLR is inadequate after hepatic resection D14
4. What is portal vein embolization? Discuss its technique and indications D11
5.Indication and methods of Portal Vein Embolization D17
6. What is ischemic preconditioning of liver? Describe the basis and how it is practiced? D12
7.ICG METABOLISM AND ITS ROLE IN HPB surgery J19
8.Atrophy hypertrophy complex of liver and its implications in surgery J19
 Liver surgery and its complications

1.Enumerate various transection techniques during liver resection. Mention advantages & limitations of any two of
them
2.Discuss in brief various liver transection techniques. D11 D13
3.Laparoscopic hepatic resection and its complications(J-19)
4.ALPPS J18 What is it and are there any variant? What is its pathophysiological basis?What are its indications, pros and cons? D18
5.Prevention and management of a patient with post liver resection liver failure D15
6.Discuss the role of Salvage transplant D17
Hydatid cyst

1. Discuss the surgical management of Hydatid disease of the Liver.

2. Discuss the management of hydatid disease of the liver D11

3. Non-surgical options in the management of hydatid disease of the liver D14
4. Diagnosis and management of cystobiliary communications in hydatid cyst of the liver D18
SOL liver, HCC
1. How will you evaluate and manage a 30 yr old lady with an incidentally detected cystic lesion in the liver on ultrasound J17

2. Classify SOL liver. How will you evaluate and treat a patient with Hep B cirrhosis found to have a 1.5cm SOL on USS abdomen
D18
3. List the predisposing factors for development of a hepatocellularcarcinoma. Diagnosis and staging of hepatocellular carcinoma.
D16
4. Outline the management of hepatocellularcarcinoma D11
5. EVidence based approach to compare resection vs transplant in HCC D19
6. Discuss the indications, technique and complications of transarterialchemo-embolization. D12
7. TARE J18
Liver transplant
Transplantation
1. Enumerate some common causes of end-stage liver disease which require liver transplantation.Briefly
discuss the evaluation of a patient with cirrhosis that requires deceased donor liver transplantation. D13
2. What is the MELD score? Discuss its usefulness in liver transplantation and other liver disorders D14
Living donor and cadaver
1. Discuss the pros and cons of Cadaveric versus Live related Liver transplantation D16 in India. D13
2. Compare the advantages and disadvantages of deceased donor and living donor liver
transplantation D16
3. Describe in detail the procedure of retrieval of liver from a brain-dead cadaver and its preservation D12.

4. Outline preoperative evaluation and assessment of a potential living donor for right lobe liver graft. D15
5. Split liver transplantation and its role in expanding cadaveric donor pool J19
Consent, Brain death and Organ donation
1. Write a short note on 'Domino LiverTransplant'

2. Different forms of consent for organ donation J17

3. What is brain stem death? How is it diagnosed and how is it certified under the Transplantation of Human Organs Act
(THOA),1994? D11
4. Define brain stem death.What are the requirments for declaration of brain stem death in India and the implications for organ
transplntation D15
5. Discuss the recent Amendments (2011) in the Transplantation of Human Organs Act (THOA)1994 D11

6. Certification of Brain stem death as per the Transplantation of Human Organs & Tissues Act. D17

7. Near relative as defined in THOTA J18

Immunosuppression and rejection

1. Immunosupression in liver transplant. Discuss the management of chronic rejection in liver transplantation. J18
2. Write short note on immunosuppression in liver transplantation. D19
3. TACROLIMUS D13
4. Describe mechanism of action of cyclosporine. Mention its uses and side effects.
5. DESCRIBE THE COMMON IMMUNOSUPPRESSIVE agents and mention a schedule of immunosupression after liver
transplantation D12
6. Hyper Acute rejection and its management D17
 Postoperative care and Complications

1. Outline the post-operative management of a patient after liver transplantation for acute liver failure. D14
2. Small for size syndrome J18
3. How will you diagnose a small for size syndrome after liver transplantation or resection? How will you manage such a patient ? D16
4. List early postoperative complication following adult liver transplantation. Outline management of 3 important ones D18
5. Enumerate the biliary complications after liver transplantation. Discuss their causes, prevention and management. D12
Biliary
Basic Investigations

1. Discuss the role of tumor markers in HBP malignancies J18 Discuss role in diagnosis and
management D19
2. Role of PET imaging in patients with hepatobiliary and pancreatic Lesions J19
D14 J17
3. Role of endoscopic ultrasound in hepato-pancreato-biliary disorders J18
4. CT vs MRI imaging in HPB disease
5. DIscuss ERCP vs MRCP for biliary & pancreatic diseases.
Misc
1. Billo Bronchial fistula - etiopathogenesis and management j19
2. Describe etiological, pathological, clinical and management differences between haemobilia and
haemosuccus pancreaticus.
Stone Disease
1. 35 yr old lady with incedentally detected assymptomatic GB stones. Approach and evidence D18
2. Describe in brief the pathogenesis of gall stone disease. How will you manage asymptomatic gall stone
disease ? D11
3. Diagnosis and management of a patient with suspected xanthogranulomatous cholecystitis J18
4. Discuss the evaluation and management of post ERCP complications D12
5. Classification, evaluation and management of intrahepatic stones J18
6. Choledochoduodenostomy - indications, contraindications and long term outcome D17

7. Classification of Mirizzi syndrome and type wise surgical treatment D13

8. Discuss the current status of Laparoscopic management of common bile duct stones.
Bile duct Injury
1. Role of HIDA scan in bile duct injury D17

2. How will you manage a case of suspected biliary injury during cholecystectomy at your hospital D11
3. Bile duct injury at a secondary level hospital, and difference at teritary care centre D18

4. Management of a patient with intraoperatively recognised transection of the common bile duct during
laparoscopic cholecystectomy D14 being done by a general surgeon at a district hospital D16
5. While doing a laparoscopic cholecystectomy, a general surgeon thinks he has transected the common bile duct.
He contacts you during the operative procedure seeking your advice. List the information that you will seek
from him, the advice that you will give him and the further management J17
6. A 30 year old lady was referred to you 72 hrs. After open cholecystectomy with pain abdomen and fever and a
drain draining 500ml bile per day. How will you evaluate and manage this patient? D13
7. Discuss the management of post cholecystectomy benign biliary Strictures J18
8. Classify post cholecystectomy benign biliary stricture. Enumerate the determinants of a
goodhepatico-jejunostomy.
Biliary Atresia

1. Outline the etiology of biliary atresia. Give its classification. Describe management strategy based on
classification.
2. Mention the etiopathogenesis of biliary atresia and classify it. Outline the management D17
3. Surgical management of biliary atresia D14
Choledochal Cysts
1. Discuss the classification and management of choledochal cysts D11

2. Classification of choledochal cysts, enumerate its complication. How will you evaluate and treat a patient a patient with type IVa
Choledochal cyst D19
3. Management of CAroli's Disease D15
4. Choledochocele D17

5. Outline the management of a patient with Caroli’s disease

RPC
Recurrent pyogenic cholangitis D19
Obstructive jaundice , biliary drainage
1. Explain the pathophysiological changes in a patient with surgical obtructive jaundice and interpretation of LFT
in such a patient D18
2. What are immunomodulators and immuno enhancers. Discuss their role and
effects on outcome following surgery in obstructive jaundice patients D13
3. Role of preoeprative biliary drainge in a patient with surgical obstructive jaundice planned for pylorus
preserving Pancreatoduodenectomy. What are the options for achieving preoperative biliary drainage. List
pros and cons J17
4. Pros and cons of preoperative biliary drainage in a resectable periampullary carcinoma D18
5. Critically evaluate the role of pre-operative biliary drainage in malignant biliary obstruction of the lower end of
CBD D11
6. Role of percutaneous transhepatic biliary drainage in patients with malignant biliary obstruction and
the possible periprocedural complications D15
7. In a patient with surgical obstructive jaundice List the various methods of percutaneous biliary drainage. Complications of
anyone method. List the absolute and relative indications for percutaneous biliary drainage J18
Hilar Cholangiocarcinoma
1. Enumerate the causes of hepatic hilar block. Discuss the management of one important etiology D11

2. Presentation, investigation and outline the management of a patient with hilar cholangiocarcinoma
D17
3. Discuss the management of type IIIa Hilar Cholangiocarcinoma.J18
4. Enumerate the causes of hepatic hilar block. Discuss the management of one important etiology.
5. Discuss the management of a 70 years old patient with obstructive jaundice due to hilar block with a
history of coronary bypass surgery ten years back D12.
6.
Ca GB

1. Discuss the 7th TNM staging of gallbladder cancer, highlighting the major changes from the previous
staging system D11
2. Staging of gallbladder cancer and its relevance in surgical management. D14

3. What do you understand by micro-metastasis? Discuss the status in gastric and gall bladder
malignancy.
4. What is the role of CT scan in the diagnosis, staging and decision making in Carcinoma gallbladder? Discuss the
current status of HPD in the management of Gall bladder D17
5. A patient underwent a laparoscopic cholecystectomy four weeks ago. The histopathology of the gall bladder
suggests carcinoma. Outline the evaluation and management of such a patient J17
6. Evaluation and management of a patient with resectable gallbladder cancer who presents with obstructive
jaundice
Pancreas
Anatomy
1. Describe the vascular anatomy of the pancreas. Discuss its relevance indifferent types of pancreatic head resections D13
Physiology
1. Evaluating pancreatic functions

2. Enumerate direct and indirect pancreatic exocrine function

 Acute Pancreatitis
1.What is autoimmune pancreatitis? b. Clinical presentation, evaluation of a suspected case of autoimmune pancreatitis and its
management D15 Pathology, diagnostic Criteria D12

2.Describe CT findings in Acute Pancreatitis. Outline the management of infected necrosis of pancreas.
3. Salient features of the Revised Atlanta classification and its implications on management of patients with acute
pancreatitis D15
4.Evaluation of a patient with acute severe necrotizing pancreatitis presenting in the first 2 weeks of illness b) Outline the
approach to such a patient with early onset organ failure D18
5. Organ failure in relation to acute severe necrotizing pancreatitis and outline their management in the first fortnight after assessment
J17
6. Discuss the management of a patient with acute pancreatitis referred to you with abdominal distension and
persistent fever in the third week of illness D12
7.Management of a patient with recurrent acute pancreatitis D14
8.Step up approach to the management of a patient with severe necrotising pancreatitis. List the indications for surgical
intervention in the first four weeks after onset of the disease D16
 Complications
1.Endoscopic management of pseudocyst of pancreas J18
2.Management of mediastinal pseudocyst of pancreas D17
3.Walled off necrosis
4.Discuss the causes, diagnsosis and treatment of pancreatic ascites D11
5.How will you diagnose and manage case of fungal sepsis in necrotizing pancreatitis?(J-19)
Chronic Pancreatitis
1. Pathophysiological basis of pain in patients with chronic pancreatitis D16
2. Evaluation of a patient with chronic calcific pancreatitis with head mass D18
3. “Endoscopic management of chronic pancreatitis is a better modality than surgical
management”. Critically analysis this statement D15
4. A 40 year old man with a history of chronic pancreatitis for 8 years develops diabetes recently. He
undergoes a CT scan which reveals a 4 cm mass in the head of the pancreas, pancreatic ductal calculi and
dilated pancreatic duct. Discuss the further evaluation of this patient. Outline the possible treatment
strategies. D13
5. Surgical interventions in a patient with chronic pancreatitis and list the pros and cons of each J17.
6. A 50 year male presents in OPD with pancreatic fistula draining 60-100 ml of pancreatic fluid 6 months after
lateral pancreatico-jejunostomy for chronic pancreatitis. Describe the investigations and treatment options D17
Cystic Neoplasms
1. Classify cystic tumors of pancreas. Describe principles of surgical management of cystic tumors of pancreas

2. Discuss evaluation and management of a patient with a cystic lesion of

pancreas D13
3. Pancreatic mucinous Cystic tumor D17

4. What is Intraductal Papillary Mucinous Neoplasm (IPMN)? Discuss its management. D11D17

5. Outline the evaluation and management of an incidentally detected space occupying cystic lesion of the
pancreas D15
6. How will you evaluate and manage a 30 year old lady with an incidentally detected cystic lesion in the
liver on ultrasound?
PNET
1. List the inherited syndromes associated with endocrine neoplasms of
pancreas and list the non GI symptoms of each
2. Discuss in brief neuro-endocrine tumors of the gastrointestinal tract D11

3. Describe the classification, current grading and methods of diagnosis of gastroentero- pancreatic neuroendocrine tumors
(GEP-NETs) D12
4. Clinical presentation, diagnosis and management of a patient suspected to have an insulinoma D16
5. Enumerate the causes and management of gastrinomas.
6. Management of neuroendocrine Liver metastasis(J-19)
Borderline resectable PDAC
1. What do you understand by the term “Borderline resectable pancreatic cancer”? Discuss the management
options J18 D15 D19
2. How will you manage a 45 yr old male with borderline pancreatic head mass with bili 5mg/dl D19
Whipples

1. Discuss concept of mesopancreas, concept of pancreatic segmentation D19

2. Critically evaluate various techniques of pancreatico-enteral anastomoses D12

3. Present status of the evidence in the on-going debate of pancreatico gastrostomy versus pancreatico jejunostomy
following pancreatico duodenectomy D18
4. Advantages and disadvantages of pancreatico-duodenectomy performed laparoscopically D16
5.
Complications of Pancreatic Surgery
1. What are the etiopathogenesis of delayed gastric emptying. Discuss the
management J19
2. External pancreatic fistula after Pancreaticoduodenectomy D13

3. How we you manage a patient who was referred to you on 3rd postoperative day following PPPD for periampullary
tumour with Bleeding through ryles tube and also through abdomen Drain? J19
4. Discuss the role of PERT after after Whipple’s D18
5. Discuss the management of a patient with peritoneal fluid amylase of 800 units (serum amylase 150
units) on the third day following Whipple'spancreaticoduodenectomy D12
Pancreatic surgery except PD, Pancreatic
Transplant
1. Current status of robotic pancreatic surgery D17

2. Total pancreatectomy - indications, technique J18

3. Discuss the type, techniques and indications of pancreatic Transplantation
D13
4. Current Status of pancreatic transplantation D14
5. Islet cell autotransplant J18
Pancreatic Trauma
1. A RTA patient is found to have D2 D3 laceration transection pancreatic neck.
Describe the management strategy D17
2. Discuss management of pancreatoduodenal Trauma J 18
Paper 3
IBD
Crohn’s Disease
1. Indeterminate colitis J18

2. Describe etiopathology of Crohn's disease. List out the differences between Crohn's disease & ulcerative colitis.
D13
3. What are the indications of surgery in Crohn's disease? Discuss in brief principles of surgical management of
Crohn's disease D11
4. Outline the evaluation of a patient with suspected Crohn's disease of the small bowel .What are the indications for surgical
management in such a patient and the possible surgical procedures? D18
5. Write a short note on clinical presentation and management of toxic megacolon.

6. What are the extra-intestinal manifestations of inflammatory bowel disease and discuss about the surgical options for
Crohn's stenotic bowel segments? J19 D12.
7. How would you suspect and confirm an anastamotic leak which occurs after a small bowel resection for Crohn's disease.
Outline your approach to the management of such a patient D16
Ulcerative colitis
1. List Truelove and Witts’ criteria for assessing severity of ulcerative colitis. b) List the components of intensive regimen for
medical management of acute severe ulcerativecolitis.c) List the indications for use of infliximab in patients with ulcerative
colitis.d) List the indications for surgery for acute severe ulcerative colitis. J16
2. Design of a study to compare a new test for the diagnosis of ulcerative colitis with the present ‘gold standard’ method

3. Management of a patient presenting with acute severe ulcerative colitis D15

4. Management of a patient of ulcerative colitis with a short segment impassable stricture 17 cm from the anal
verge. b) How will you follow up such a patient? J17
5. Describe in details surgical indications and type of surgery with its outcome in chronic
ulcerative colitis D17
6. ATZ (Anal Transition Zone) and its relevance in surgery for ulcerative colitis J18
Pouch
1. What is Pouchitis? Describe its pathophysiology and management? D12
2. Refractory pouchitis, discuss causes and maangement D19
3. Management of pouch-vaginal fistulae D14

4. Pouch Vaginal fistula - surgical options and its indication D17

5.
Colon
Anatomy
1. Vascular supply of the colon D18
2. Arterial supply of the colon and its relevance in using the colon for reconstruction in corrosive injury of the
esophagus D15
3. Anatomy of the colon in relation to its use as replacement organs after esophagectomy with emphasis
on its vascular supply J17
4. Nerve supply to the rectum and anal canal. Explain the sites of injuries and technique of
avoiding injuries to these nerves during anterior resection
Benign Disorders
1. What are the causes and complications of colonic diverticula? D14

2. Outline the evaluation of a patient with a colonic motility disorder D15

3. Etiology and pathogenesis of SRUS (solitary rectal ulcer syndrome) J17

4. Etiopathogenesis and management of rectovaginal fistula J17

5. Colonic Transit Time (CTI) & its role in chronic constipation D17
6. Grades Rectal Prolapse. Outline management options for a 28 yr old with complete rectal prolapse D19
Obstructed Defecation Syndrome
1. Evaluation and management of patients with obstructed defecation syndrome (ODS) J19
2. What is Obstructed Defecation Syndrome? How will you evaluate a patient of obstructed
defecation? Outline the non-surgical and surgical treatment.
3. What is Obstructed Defecation Syndrome (ODS)? Write its etiopathogenesis and evaluation
strategy which may help to decide the treatment D13
4. STARR indications and outcome D17
Preoperative bowel preparation, antibiotics

1. What is the current perspective on pre-operative colon preparation? Discuss the associated
controversies D12
2. Current status of ‘mechanical bowel preparation’ in colorectal surgery J17
3. What is the role of prophylactic antibiotics in colorectal surgery? What is the impact of antibiotics
resistance on the outcome of patients undergoing surgery? What measures can be taken to decrease
this impact? D15
Colon Cancer
1. Describe the genetic basis of Colorectal cancer D12

2. Describe the adenoma-carcinoma sequence in detail. Discuss the role of specific genes at its Different points. How does it play
its role in disease control?
3. KRAS and BRAF mutations in Colorectal cancer

4. Familial polyposis coli D14

5. Peutz-Jegher Syndrome D17

6. Microsatellite instability and colorectal cancer D17

7. Management of a patient with familial adenomatous polyposis syndrome who has a cancer of the mid transverse
colon D18
8. Role of complete mesocolic excision in colon cancer management D17

9. What is the current status of laparoscopic colorectal surgery in cancer patients? Justify your statements by
giving summary of the important trials. D13
10. Colorectal GIST. Rectal NET D19
Colorectal Liver metastases
1. PET vs MRI in the evaluation of CRLM D13

2. Compare liver first to simultaneous resection in CRLM D19

Rectal Cancer Philosophy
1. Discuss the anatomy of rectum and the anatomical landmarks of mesorectum with respect to rectal carcinoma J18

2. Role of MRI in carcinoma rectum D17

3. Write short notes on Neoadjuvant therapy in rectal cancer D11
4. Role of short course RT with consolidated chemotherapy D17 D19

5. Outline the management options of a patient we mid third rectal cancer rectum with a solitary metastasis in segments
5&6 of the liver D18
Rectal Cancer Surgery
1. What are the indications for doing a diverting ileostomy after anterior resection for carcinoma rectum?
List the advantages and disadvantages of a diverting ileostomy in such a patient over a diverting
colostomy D16
2. Describe technique and limitations of ultra-low anterior resection for rectal cancer.

3. Total mesorectal excision & its role in the surgery of rectal cancers d14
4. Total mesorectal excision - Technique, indications & complications D13
5. What is pelvic exenteration Mentions its indications contraindications and outcome in patients with fow rectal cancer
J19
6. Extralevator abdominoperineal excision: Outline procedure, discuss its role and the pros and cons D18
7. Compare and contrast ELAPE vs APR
8. Surgical approach to a patient with a malignant lesion 5cm from the anal verge J17
Anal Canal
 Fecal Incontinence
1. Management of a patient with faecal incontinence after a minor anal operation D14
2. List causes of faecal incontinence. b) Pathophysiology of faecal incontinence. D16