HESHAMRCS ((ALL IN
ONE )) ((Surgery))
1. 1st Investigation to be done in Biliary pathology – USG
2. IOC for acute cholecystitis (Gold Standard) – HIDA Scan
3. IOC for CBD Stone (Gold Standard)- ERCP
4. IOC to study the CBD pathology – MRCP
5. Charcot’s triad – Cholangitis (Pain + jaundice + Rigors)
6. Hepatic venography showing Spider web appearance - Budd Chiari syndrome
7. Water Lilly appearance – Hydatid cyst
8. Most cause of Portal hypertension – Cirrhosis
9. Most common cause of pyogenic liver abscess in India – Klebsiella
10. Most common primary GIT tumor in childhood – Hepatoblastoma
11. Most common benign tumor in young females on OCP – Hepatic adenoma
12. Gold standard for GERD – 24 hrs Ambulatory pH monitoring
13. Bird Beak/Pencil Tip/Abrupt cut off/Hurst Phenomenon on Barium Swallow –
Achlasia
14. Rat tail/Irregular Narrowing with Proximal dilated esophagus – Cancer
esophagus
15. Cork screw Esophagus – Diffuse Esophageal Spasm
16. Most common site of Varices in portal Hypertension – Lower Esophageal
Varices > Gastric varices
17. Most common complication of GERD – Esophagitis
18. IOC to diagnose H. Pylori – ELISA
1|Page
19. IOC to diagnose Meckel’s in Children Preoperatively – Tc 99m Pertechnicate
scan
20. Apple core appearance in barium Enema – Carcinoma Colon
21. Bird Beak sign in barium enema – Sigmoid Volvulus
22. Coffee bean sign (Bent Inner Tube) in X ray – Sigmoid Volvulus
23. Most common site of TB in intestine – Terminal Ileum and IC valve
24. Tb produces – Transverse Ulcer (Typhoid – Longitudinal Ulcer)
25. Most common cause of Small Intestine Obstruction in Children –
intussusception
26. Most common site of carcinoid tumors – Bronchus > Ileum > Rectum
27. Most common site of colorectal cancers – rectum > Sigmoid Colon (Overall
left colon cancers are common)
28. IOC for Fistula in Ano – MRI Fistulogram
29. Raspberry tumor – Umbilical adenoma (persistent distal Vitello intestinal
Duct)
30. Most common of peritonitis in Children – Streptococci
31. Most commonly used blood test to diagnose Acute Pancreatitis – Serum
Amylase
32. Most Sensitive – Serum lipase
33. Most Specific – Serum lipase
34. Radiological Investigation of choice for Acute pancreatitis – CECT abdomen
(Done > 72 hrs)
35. Radiological IOC for Chronic Pancreatitis CECT abdomen
36. Gold Standard to diagnose early Chronic pancreatitis – ERCP (Cambridge
Criteria)
37. Chain of Lakes appearance – Chronic pancreatitis (in ERCP)
2|Page
38. Double Duct sign – Cancer pancreas shows separated ducts (pancreas and
Bile duct) in ERCP
39. IOC fort Pancreatic cancer – CECT abdomen
40. IOC to diagnose Insulinoma – 72 hrs FBS and Insulin level
41. IOC to diagnose Gastrinoma – Serum Gastrin
42. Grey turner sign – Loin pigmentation in hemorrhagic pancreatitis
43. Cullen’s sign – Periumbilical pigmentation in hemorrhagic pancreatitis
44. Most common endocrine neoplasm in MEN – 1 Syndrome – Gastrinoma
45. Ranula – Extravasation cyst of submandibular gland
46. Ludwig’s angina – Rapidly progressive cellulitis of Submandibular space
47. Oral cancer common in India – Buccal mucosa cancer
48. Oral Cancer common in World – tongue Cancer
49. Most common site for squamous cell carcinoma salivary gland –
submandibular gland
50. Triple screening – Clinical Examination + radiological Examination +
Pathological Examination
51. IOC for Screening breast cancer in Old age – Mammography
52. IOC for screening high risk cases – MRI
53. IOC for implant breast screening – MRI
54. Nipple blood discharge – Cancer is mc cause in Old age (Young age – Duct
Papilloma)
55. Most common site of cancer breast – Upper outer quadrant
56. SERM- Selective estrogen receptor modulators – Raloxifene, idoxifene,
Toremifine
3|Page
Triads In General
Surgery
Triad of Coagulopathy
Acidosis
Hypothermia
Physiological exhaustion
Deadly triad (lethal triad) of trauma
Hypothermia,
Acidosis
Coagulopathy
Cushing’s triad (head injury)
Hypertension,
Bradycardia
Irregular respiration
Mass lesion brain (ICSOL)
Focal deficits,
Seizures
Raised ICP
Menière’s disease
Intermittent attacks of vertigo,
Fluctuating sensorineural hearing loss
Tinnitus
Whipple’s triad (Insulinoma)
Symptoms of hypoglycaemia after fasting or exercise,
Plasma glucose levels <2.8mmol/l,
Relief of symptoms on intravenous administration of glucose
4|Page
Men 1 (Wermer syndrome)
Tumor in the anterior pituitary gland,
Hyperplasia of the parathyroids
Pancreaticoduodenal endocrine tumors
Ruptured abdominal aortic aneurysm
Severe abdominal and/or back pain,
Hypotension
Pulsatile abdominal mass.
GERD
Retrosternal burning pain (heartburn),
Epigastric pain
Regurgitation.
Charcot’s triad (Cholangitis)
Upper quadrant pain
Jaundice
Fever
Reynolds pentad
Charcot triad +
Hypotension and
Mental status changes (both evidence of shock)
Rigler’s triad (Radiological sign of gallstone ileus )
Small bowel obstruction,
Pneumobilia
An atypical mineral shadow on radiographs of the abdomen
Reiter’s disease
Urethritis or diarrhoea,
Conjunctivitis and
Polyarthritis
Enterocutaneous fistulas
Sepsis,
5|Page
Fluid and electrolyte imbalance,
Malnutrition
Virchow triad
Endothelial injury,
Venous stasis,
Hypercoagulable state.
Graves disease
Signs and symptoms of thyrotoxicosis,
Goiter,
Exophthalmos
Pheochromocytoma
Headache,
Diaphoresis,
Palpitations
Achalasia
Dysphagia,
Regurgitation,
Weight loss
Haemobila
Upper GIT hemorrhage,
Right upper quadrant pain,
Jaundice
Zollinger - Ellison syndrome
Gastric acid hypersecretion, severe PUD,
and non–β-islet cell
Tumors of the pancreas
Carney triad
Gastric gastrointestinal stromal tumor,
Pulmonary chondroma,
Extra-adrenal paraganglioma
6|Page
Borchardt triad (Gastric Volvulus)
Sudden onset of constant and severe upper abdominal pain,
Recurrent retching with production of little vomitus,
Inability to pass a nasogastric tube
Crohns disease
Abdominal pain,
Diarrhea,
Weight loss
Portal triad
Portal vein,
Hepatic artery,
And bile duct
Choledochal cyst
Jaundice,
A palpable right upper quadrant mass,
abdominal pain
Intestinal obstruction
Abdominal pain,
Vomiting,
Obstipation.
Urethral injury
Blood at the urethral meatus,
Inability to void,
A palpably distended bladder
Renal cell carcinoma (classic <10%)
Flank pain,
Gross hematuria, and
Palpable abdominal mass
Beck’s triad (Cardiac Tamponade)
Hypotension,
7|Page
Muffled heart tones,
Neck vein distention.
Auscultatory triad of mitral stenosis.
Increased first heart sound
Opening snap
Apical diastolic rumble.
Small bowel obstruction (X-ray abdomen)
Dilated small bowel loops (>3 cm ),
Air-fluid levels seen on upright films,
Paucity of air in the colon
Felty’s syndrome
Rheumatoid arthritis,
Splenomegaly,
Neutropenia
Prune-belly syndrome (also known as Eagle-Barrett syndrome
and the triad syndrome)
Extremely lax lower abdominal musculature,
Dilated urinary tract including the bladder,
Bilateral undescended testes
Terrible triad
An elbow dislocation,
A radial head fracture,
Coronoid fracture
Unhappy triad (O'donoghue's triad)
Mcl,
Medial meniscus,
Acl injury
8|Page
