PGIM CSE Surgical Specialties cheat sheet

Acute appendicitis: Alvarado score ≥7 supports operative management; CT/US reserved for equivocal cases, women of childbearing age, or elderly.

Small bowel obstruction: CT identifies transition point and strangulation; water-soluble contrast challenge predicts resolution in adhesive SBO without peritonitis.

Perforated peptic ulcer: omental (Graham) patch repair plus peritoneal lavage; add highly selective vagotomy only in selected stable cases.

Boerhaave syndrome: transmural esophageal rupture with mediastinitis; contrast swallow and CT confirm; broad-spectrum antibiotics plus drainage/surgery.

Damage control laparotomy: temporary abdominal closure, correction of acidosis, hypothermia, coagulopathy; planned relook at 24-48 h.

Hernia: indirect inguinal passes lateral to inferior epigastric vessels; direct passes medial; femoral hernia lies below and lateral to pubic tubercle.

Acute mesenteric ischemia: disproportionate pain, lactic acidosis, AF; CT angiography is first-line; revascularization before resection.

Clostridium difficile colitis: toxic megacolon or perforation mandates subtotal colectomy with end ileostomy.

Gastric outlet obstruction: exclude malignancy by endoscopy; metabolic alkalosis and hypokalemia from vomiting require correction preoperatively.

Acute cholecystitis: early laparoscopic cholecystectomy within 72 h of presentation is preferred to delayed interval surgery.

Choledocholithiasis: MRCP or EUS for suspected CBD stones; ERCP with sphincterotomy for confirmed stones with cholangitis or obstruction.

Charcot triad (fever, RUQ pain, jaundice) suggests cholangitis; Reynolds pentad adds hypotension and confusion, indicating urgent biliary drainage.

Pancreatic adenocarcinoma: resectability assessed by vascular involvement; FOLFIRINOX or gemcitabine-nab-paclitaxel for borderline/advanced disease.

Post-ERCP pancreatitis prophylaxis: rectal NSAIDs plus hydration in high-risk patients.

Acute pancreatitis: severity by revised Atlanta criteria; fluid resuscitation, enteral nutrition when tolerated; antibiotics only for infected necrosis.

Hepatic adenoma: >5 cm or β-catenin activation carries rupture/malignancy risk; resection or cessation of OCPs considered.

HCC surveillance: ultrasound with or without AFP every 6 months in cirrhosis; LI-RADS imaging criteria allow non-invasive diagnosis.

Pancreatic pseudocyst: mature wall after ≥4 weeks; symptomatic or enlarging cysts warrant endoscopic cystogastrostomy or drainage.

Colorectal cancer staging: T stage by depth of invasion, N by nodal involvement; neoadjuvant chemoradiation for locally advanced rectal cancer (T3/T4 or N+).

Total mesorectal excision is standard for rectal cancer; sharp dissection along the mesorectal fascia reduces local recurrence.

Anastomotic leak after colorectal surgery: tachycardia, fever, peritonitis; CT with contrast and urgent reoperation if unstable.

Diverticulitis: Hinchey classification guides management; percutaneous drainage for abscess, resection for generalized peritonitis.

Hemorrhoids: grade I-II managed conservatively (fiber, rubber band ligation); grade III-IV may need surgical hemorrhoidectomy.

Anal fissure: lateral internal sphincterotomy for chronic fissure refractory to medical therapy; caution in incontinence risk.

Fistula-in-ano: Goodsall rule predicts tract course; MRI or EUA for complex or recurrent fistulas.

Ulcerative colitis: acute severe colitis failing IV steroids within 3-5 days needs colectomy; toxic megacolon is a surgical emergency.

Breast cancer: triple assessment (clinical, imaging, core biopsy); sentinel node biopsy for clinically node-negative axilla.

HER2-positive breast cancer: trastuzumab-based therapy; ER-positive disease benefits from endocrine therapy (tamoxifen or aromatase inhibitor).

DCIS: breast-conserving surgery plus radiotherapy; margins ≥2 mm accepted; sentinel node biopsy generally avoided unless mastectomy.

Thyroid nodule: Bethesda category guides management; Bethesda V/VI or suspicious ultrasound features warrant surgery.

Papillary thyroid carcinoma: total thyroidectomy with central neck dissection for nodal disease; radioiodine for high-risk features.

Primary hyperparathyroidism: elevated calcium with inappropriately normal/high PTH; sestamibi or ultrasound for localization; parathyroidectomy is definitive.

Pheochromocytoma: alpha-blockade before beta-blockade to prevent hypertensive crisis; biochemical screening with plasma metanephrines.

Adrenal incidentaloma: assess hormonal function and imaging characteristics; size >4 cm or suspicious features favor resection.

Abdominal aortic aneurysm: repair indicated at ≥5.5 cm in men or rapid growth >1 cm/year; EVAR vs open repair based on anatomy and fitness.

Ruptured AAA: permissive hypotension, immediate transfer to theatre; endovascular repair reduces early mortality in suitable anatomy.

Acute limb ischemia: Rutherford classification; heparin immediately, urgent revascularization (embolectomy, thrombolysis, or bypass).

Carotid stenosis: endarterectomy for symptomatic ≥70% stenosis; consider for 50-69%; best within 2 weeks of symptoms.

Peripheral arterial disease: ABPI <0.9 suggests disease; exercise and best medical therapy first; revascularization for lifestyle-limiting claudication or critical limb ischemia.

Varicose veins: duplex ultrasound to map reflux; endovenous ablation preferred over open surgery for great saphenous reflux.

Aortic dissection: Stanford type A requires emergency surgery; type B managed medically unless complicated.

Graft infection: Staphylococcus aureus common; excision of infected graft with extra-anatomic bypass or in situ reconstruction.

Open fractures: urgent antibiotics, tetanus prophylaxis, and debridement; Gustilo-Anderson grade guides fixation strategy.

Compartment syndrome: pain out of proportion, pain on passive stretch; fasciotomy is emergency; pressure >30 mmHg or delta <30 mmHg supports diagnosis.

Hip fracture: early surgery within 48 h reduces morbidity; intracapsular fractures in elderly may need arthroplasty.

Pediatric supracondylar fracture: Gartland classification; type III needs reduction and pinning; monitor for compartment syndrome and vascular injury.

Anterior cruciate ligament tear: Lachman test most sensitive; MRI confirms; reconstruction for instability in active patients.

Osteomyelitis: bone biopsy for culture before antibiotics; MRI is sensitive; prolonged targeted antibiotics plus surgical debridement.

Cauda equina syndrome: saddle anesthesia, urinary retention, bilateral sciatica; urgent MRI and decompression within 24-48 h.

Developmental dysplasia of the hip: Ortolani and Barlow tests in neonates; ultrasound screening; Pavlik harness for young infants.

Traumatic brain injury: GCS ≤8 warrants intubation; avoid hypotension and hypoxia; CT shows hematoma, contusion, or diffuse axonal injury.

Extradural hematoma: lens-shaped, middle meningeal artery tear; urgent craniotomy for expanding or symptomatic lesions.

Subdural hematoma: crescent-shaped; acute with mass effect needs evacuation; chronic may be managed with burr hole drainage.

Aneurysmal subarachnoid hemorrhage: CT within 6 h highly sensitive; LP if CT negative; nimodipine reduces vasospasm-related deficits.

Hydrocephalus: endoscopic third ventriculostomy or shunt; shunt infection/malfunction presents with headache, vomiting, and altered consciousness.

Brain metastases: stereotactic radiosurgery for limited lesions; whole-brain radiotherapy for multiple lesions; dexamethasone for edema.

Lumbar disc herniation: conservative management first; surgery for progressive deficit, cauda equina, or refractory pain.

Glioblastoma: maximal safe resection followed by temozolomide and radiotherapy; MGMT promoter methylation predicts response.

Coronary artery bypass grafting: left internal mammary artery to LAD improves patency; consider for multivessel disease or diabetes with suitable anatomy.

Aortic stenosis: severe symptomatic disease warrants valve replacement; TAVI for high surgical risk, SAVR for lower risk.

Postoperative atrial fibrillation after cardiac surgery: rate control and anticoagulation based on stroke risk; amiodarone for rhythm control.

Lung cancer resection: lobectomy preferred for stage I-II NSCLC; mediastinal staging with EBUS or mediastinoscopy before surgery.

Pneumothorax: large or symptomatic requires chest drain; tension pneumothorax needs immediate needle decompression.

Empyema: staged management with antibiotics, chest drainage, and decortication or VATS for organized collections.

Cardiac tamponade: Beck triad (hypotension, distended neck veins, muffled heart sounds); pericardiocentesis or surgical drainage.

Thoracic trauma: massive hemothorax >1500 mL or >200 mL/h requires thoracotomy; resuscitative thoracotomy for penetrating arrest with signs of life.

Renal colic: CT KUB is first-line; NSAIDs for pain; stones <10 mm may pass; ureteroscopy or ESWL for larger or obstructing stones.

Testicular torsion: immediate exploration; do not delay for imaging when clinical suspicion is high; bilateral orchidopexy if viable.

Prostate cancer: PSA, DRE, and MRI-targeted biopsy; Gleason/Grade Group guides risk stratification and treatment.

Bladder cancer: painless hematuria warrants cystoscopy; non-muscle-invasive disease managed with TURBT and intravesical therapy.

Kidney transplant: live donor preferred; immunosuppression with calcineurin inhibitor, antimetabolite, and steroid; monitor for rejection and infection.

Transplant rejection: hyperacute (preformed antibodies), acute (cellular), chronic (graft vasculopathy); biopsy guides management.

Ureteric injury: recognized intraoperatively during pelvic surgery; stenting or reimplantation; delayed presentation with urinoma or fistula.

Benign prostatic hyperplasia: alpha-blockers and 5-alpha reductase inhibitors; surgery (TURP) for refractory symptoms or complications.

Skin grafts: split-thickness for large defects, full-thickness for contracture-prone areas; graft survival depends on vascularized bed.

Flap monitoring: color, capillary refill, temperature, and Doppler signal; early re-exploration for arterial or venous compromise.

Burn resuscitation: Parkland formula 4 mL/kg/%TBSA crystalloid in first 24 h; half in first 8 h; adjust to urine output.

Burns: escharotomy for circumferential full-thickness burns with compartment compromise; early excision and grafting improve outcomes.

Breast reconstruction: implant-based vs autologous; acellular dermal matrix and radiotherapy affect complication rates.

Cleft lip and palate: lip repair around 3 months, palate repair around 9-12 months; multidisciplinary team care.

Hand injuries: assess tendon, nerve, and vascular integrity; early repair and rehabilitation; compartment syndrome risk with crush injuries.

Pressure ulcers: staging by depth; debridement and offloading; flap coverage for deep defects over pressure points.

Hypertrophic pyloric stenosis: non-bilious projectile vomiting at 3-6 weeks; ultrasound shows pyloric thickness >3 mm; correct electrolytes before pyloromyotomy.

Intussusception: colicky pain, red-currant stool; ultrasound shows target sign; air or contrast enema is diagnostic and therapeutic.

Malrotation with volvulus: bilious vomiting in neonate is surgical emergency; urgent upper GI contrast and laparotomy.

Necrotizing enterocolitis: preterm infants with feeding intolerance, abdominal distension, pneumatosis; bowel rest, antibiotics, surgery for perforation.

Inguinal hernia in infants: risk of incarceration; early repair; contralateral exploration not routine.

Undescended testis: orchidopexy by 12-18 months; risk of malignancy and infertility if untreated.

Biliary atresia: jaundice beyond 2 weeks with pale stools; Kasai portoenterostomy before 60 days improves outcomes.

Appendicitis in children: atypical presentation; ultrasound first; perforation common in young children.

Preoperative risk: ASA classification and functional capacity; cardiopulmonary exercise testing for high-risk major surgery.

Enhanced recovery after surgery: carbohydrate loading, multimodal analgesia, early mobilization, early enteral feeding, opioid-sparing.

Venous thromboembolism prophylaxis: risk-stratify; mechanical plus pharmacologic prophylaxis for major abdominal/pelvic surgery.

Perioperative antibiotics: administer within 60 min before incision; redose for prolonged surgery or significant blood loss.

Perioperative glucose: target 6-10 mmol/L; hyperglycemia increases infection and morbidity.

Fluid therapy: balanced crystalloids; avoid excessive saline; goal-directed therapy for high-risk patients.

Postoperative nausea and vomiting: multimodal prophylaxis with dexamethasone, ondansetron, and droperidol in high-risk patients.

Perioperative hypothermia: active warming maintains normothermia; reduces surgical site infection and cardiac events.

WHO surgical safety checklist: sign in, time out, sign out; reduces morbidity and mortality when used reliably.

Wrong-site surgery prevention: marking, verification, and team briefing; never assume laterality from imaging alone.

Retained surgical items: counts and radiofrequency detection; report as never event; investigate and disclose.

Medication safety: high-alert medications (insulin, anticoagulants, opioids) require independent double-checks and standardized concentrations.

Hand hygiene: WHO five moments; alcohol-based rub preferred unless hands visibly soiled.

Pressure injuries: risk assessment (Braden), repositioning, and skin care; report stage 3-4 as serious incidents.

Duty of candour: disclose harm promptly and honestly; apologize and explain; document the discussion.

Human factors: fatigue, hierarchy, and distraction contribute to error; briefings and checklists mitigate.

Informed consent: capacity, voluntariness, and adequate information; discuss material risks and alternatives.

Confidentiality: disclose only with consent or legal obligation; exceptions include public safety and court order.

Capacity assessment: understand, retain, weigh, and communicate decision; assumption of capacity unless proven otherwise.

Conflicts of interest: declare financial and personal interests; manage or withdraw from decision-making.

Professional boundaries: avoid dual relationships; maintain appropriate communication and social media conduct.

Error disclosure: explain what happened, impact, and next steps; support patient and family; document.

Teamwork and speaking up: psychological safety; escalate concerns about unsafe practice through appropriate channels.

Continuing professional development: reflective practice and audit; maintain competence and revalidation requirements.