Q1 50M Compulsory enumerate Cardiac imaging, anxiety disorders, pediatric diarrhea, vaccines, scabies
(a) Enumerate the imaging modalities used in the diagnosis of cardiac diseases. List their specific indications in diagnosing cardiac illnesses. (10 marks)
(b) Outline the pharmacological and non-pharmacological management of anxiety disorders. (10 marks)
(c) A 3 year old girl, who weighs 12 kg, presents with a history of loose stools mixed with blood and mucus, and fever for 3 days. On examination, she is active and feeling excessively thirsty. There is some loss of skin turgor.
(i) Write your complete diagnosis.
(ii) Name the most common micro-organism responsible for this condition.
(iii) Write two most important life-threatening complications of this condition.
(iv) Outline the management of the condition in this girl. (2+2+2+4=10 marks)
(d) (i) Give two examples for each of the following types of vaccines used in under-5 children:
1. Capsular polysaccharide vaccines
2. Conjugate vaccines
3. Recombinant vaccines
(ii) Define the following terms:
1. Herd effect
2. Vaccine efficacy (6+4=10 marks)
(e) (i) State the various modes of transmission of scabies.
(ii) What is the mite burden in a classical case of scabies during
1. an initial infection
2. in reinfection
3. in Norwegian scabies
(iii) Describe the distribution of cutaneous findings in scabies. (4+3+3=10 marks)
Answer approach & key points
Begin with the directive 'enumerate' for part (a), then apply 'outline' for (b) and (c)(iv), 'state/define' for (d)(ii) and (e)(i), and 'describe' for (e)(iii). Allocate approximately 20% time to each of the five main parts (a-e), with sub-part (c) requiring integrated clinical reasoning across its four components. Structure as: (a) tabulated modalities with indications; (b) two-column pharmacological vs non-pharmacological; (c) clinical case synthesis with dehydration assessment; (d) vaccine examples in list format with precise definitions; (e) transmission modes with mite burden specifics and distribution description. No conclusion needed; maximize information density within each marked section.
- (a) Cardiac imaging: ECG, chest X-ray, echocardiography (TTE/TEE), stress testing, cardiac CT, cardiac MRI, nuclear imaging (MUGA, PET), cardiac catheterization with indications for each (e.g., TTE for initial valve assessment, CMR for myocarditis, coronary angiography for CAD)
- (b) Anxiety disorders: Pharmacological (SSRIs first-line, SNRIs, benzodiazepines short-term, buspirone, beta-blockers for somatic symptoms) and non-pharmacological (CBT, exposure therapy, relaxation techniques, lifestyle modifications)
- (c)(i-iv) Pediatric dysentery: Acute bacillary dysentery with some dehydration (WHO Plan B), Shigella flexneri/most commonly S. sonnei in developed settings, complications (hemolytic uremic syndrome, toxic megacolon/septic shock), ORS/zinc/antibiotics (azithromycin/cefixime) with monitoring
- (d) Vaccine types: Capsular polysaccharide (Pneumococcal 23-valent, Meningococcal ACWY), Conjugate (Hib, PCV13, MenACWY-CRM), Recombinant (Hepatitis B, HPV); Herd effect (indirect protection of unvaccinated), Vaccine efficacy (protection in controlled trial vs placebo)
- (e) Scabies: Transmission (direct skin contact, fomites, sexual transmission), mite burden (10-15 in classical initial, rapid increase in reinfection, millions in Norwegian/crusted scabies), distribution (finger webs, wrists, elbows, axillae, periumbilical, groin, buttocks, sparing of head in adults)
Q2 50M discuss Nephrotic syndrome, pediatric pneumonia, lichen planus
(a) Discuss in brief the etiology, clinical features, diagnosis and treatment of nephrotic syndrome in a 40 year old adult. (20 marks)
(b) A 2 year old unimmunized boy weighing 6 kg presented with fever, cough, and difficult breathing for 5 days. There was a history of fever with maculopapular rash lasting for 3 days around 7 days prior to this episode. The child is febrile, has a pulse rate 116/min, respiratory rate : 72/min, SpO₂ 88%. There is severe chest indrawing and nasal flaring. Auscultation revealed bronchial breath sounds on left side and bilateral crepitations.
(i) State the complete diagnosis.
(ii) Enumerate 3 most important complications associated with this condition.
(iii) How would you assess the severity of illness in this child ?
(iv) Discuss in brief the management of this child. (3+3+3+6=15 marks)
(c) (i) What are the four 'P's used to describe clinical manifestation of lichen planus ?
(ii) What are the common sites of cutaneous involvement in lichen planus ?
(iii) Describe Koebner phenomena. List the disorders where this phenomena can be observed. (5+5+5=15 marks)
Answer approach & key points
This multi-part question requires a structured response across three distinct clinical scenarios. Allocate approximately 40% of time/words to part (a) on adult nephrotic syndrome (20 marks), 30% to part (b) on pediatric pneumonia with its four sub-parts (15 marks), and 30% to part (c) on lichen planus with its three sub-parts (15 marks). Begin each part with clear headings, use bullet points for sub-parts (b)(i)-(iv) and (c)(i)-(iii), and ensure clinical reasoning is explicit throughout.
- Part (a): Etiology of adult nephrotic syndrome distinguishing primary (minimal change disease, FSGS, membranous nephropathy, MPGN) vs secondary causes (diabetes, amyloidosis, SLE, infections, drugs); clinical features emphasizing edema, proteinuria >3.5g/day, hypoalbuminemia, hyperlipidemia; diagnosis including urine analysis, 24-hour urine protein, serum albumin, lipid profile, renal biopsy indications; treatment with ACE inhibitors, steroids, immunosuppressants, and complications management
- Part (b)(i): Complete diagnosis as Measles complicated by severe pneumonia (likely bacterial superinfection) with respiratory distress, recognizing the 7-day interval between measles rash and current presentation as characteristic of measles-associated immune suppression
- Part (b)(ii): Three most important complications: respiratory failure/ARDS, bacterial superinfection (Staphylococcus aureus, Streptococcus pneumoniae, H. influenzae), and measles croup/subglottic obstruction; or alternatively sepsis, empyema, or heart failure
- Part (b)(iii): Severity assessment using WHO IMCI criteria or PAEDIATRIC RISK OF MORTALITY (PRISM) score, specifically noting danger signs: SpO₂ <90%, chest indrawing, nasal flaring, RR >70/min in <2 months (or >60 in 2-12 months), inability to feed, altered consciousness
- Part (b)(iv): Management including oxygen therapy (target SpO₂ >92%), IV antibiotics (ampicillin/ceftriaxone ± gentamicin or vancomycin if MRSA suspected), bronchodilators, hydration, nutrition support, measles vitamin A supplementation, and possible ICU referral for respiratory failure
- Part (c)(i): Four 'P's of lichen planus - Pruritic, Purple, Polygonal, Papules/Plaques (sometimes including fifth P: Planar surfaces)
- Part (c)(ii): Common sites: flexor wrists, forearms, ankles, lumbar region, oral mucosa (buccal, tongue, gingiva), scalp (lichen planopilaris), nails, and genitalia
- Part (c)(iii): Koebner phenomenon definition (isomorphic response - appearance of lesions at sites of trauma); associated disorders: psoriasis, lichen planus, vitiligo, molluscum contagiosum, flat warts, Darier disease
Q3 50M discuss Diabetes mellitus, lactation failure, diaper dermatitis
(a) (i) Discuss in brief about the diet and exercise related advice given to a 35 year old male diagnosed with non-insulin dependent diabetes mellitus.
(ii) Write the acute complications of Insulin dependent diabetes mellitus and outline their management.
10+10=20
(b) A 22 year old primi mother comes to you with complaint of "NOT ENOUGH MILK". Due to this, her baby remains hungry and is constantly biting at her nipples. She is feeling soreness in the nipples.
(i) How will you assess the mother-child duo to identify the underlying etiology of "NOT ENOUGH MILK" ? Discuss briefly.
(ii) Outline the 4 criteria each for "correct positioning" and "correct attachment" of the baby for proper breastfeeding.
(iii) Discuss in brief the management of sore nipples.
8+4+3=15
(c) Following an acute episode of diarrhoea a 3 month old infant wearing diaper daily develops rash on skin surfaces that are in direct contact with diaper.
(i) What is your diagnosis ? Describe clinical picture of this disorder.
(ii) How do you treat skin condition of this child ?
10+5=15
Answer approach & key points
The directive 'discuss' requires comprehensive coverage with critical analysis across all sub-parts. Allocate ~40% time/words to part (a) [20 marks], ~30% to part (b) [15 marks], and ~30% to part (c) [15 marks]. Structure: brief introduction on common themes (preventive care, maternal-child health, pediatric dermatology) → systematic coverage of each sub-part with clinical reasoning → concluding synthesis on primary care approach.
- For (a)(i): Dietary advice for T2DM—caloric restriction, low glycemic index foods, DASH/Mediterranean pattern, carbohydrate counting, fiber intake; Exercise—150 min/week moderate aerobic activity, resistance training, hypoglycemia precautions
- For (a)(ii): Acute complications of T1DM—DKA (pathophysiology: insulin deficiency → lipolysis → ketogenesis → metabolic acidosis) and hypoglycemia; management protocols including fluid resuscitation, insulin infusion, potassium replacement, cerebral edema monitoring
- For (b)(i): Assessment of lactation failure—maternal factors (prolactin levels, breast examination for hypoplasia/inversion, hydration/nutrition, psychosocial stress), infant factors (birth weight, gestational age, oral anatomy, suckling assessment, weight gain trajectory)
- For (b)(ii): WHO/UNICEF criteria for correct positioning (head-body alignment, close to mother, nose-to-nipple alignment, supported whole body) and correct attachment (wide mouth, lower lip everted, chin touching breast, more areola visible above)
- For (b)(iii): Sore nipple management—correct technique education, topical purified lanolin, hydrogel dressings, breast shells, treatment of candidiasis/bacterial infection if present, temporary pumping
- For (c)(i)-(ii): Diaper dermatitis—irritant contact type vs. candidal superinfection; clinical features (erythema sparing skin folds for irritant, involvement of folds with satellite lesions for candida); barrier creams (zinc oxide), antifungals (nystatin/clotrimazole), superabsorbent diapers, air exposure
Q4 50M outline Thyroid disorders, IMNCI, adverse drug reaction
(a) A 25 year old female has presented to the medicine OPD with complaints of excessive tiredness, cold intolerance and menstrual irregularities.
(i) Write the name of thyroid disorder that can lead to above manifestations.
(ii) Tabulate the differentiating cardiovascular clinical manifestations in hypothyroidism and hyperthyroidism.
(iii) Outline the pharmacological management of hypothyroidism and hyperthyroidism. What are the blood investigations conducted to monitor the treatment of hypothyroidism and hyperthyroidism ?
2+8+10=20
(b) A 6 week old sick looking young infant is brought to a primary health centre with suspicion of "Possible Bacterial Infection" as per Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy.
(i) How will you assess this child, and classify as having "Possible Serious Bacterial Infection" or "Local Bacterial Infection" ?
(ii) State the treatments for "Possible Serious Bacterial Infection" and "Local Bacterial Infection", as per IMNCI strategy.
10+10=20
(c) A young epileptic patient was put on antiseizure drug Lamotrigine. Three weeks later he develops an eruption consisting of purpuric macules and bullae all over skin with involvement of lips, oral mucous membrane and eyes. Skin was tender to touch.
(i) What is the differential diagnosis in this case ?
(ii) How will you manage this condition ?
5+5=10
Answer approach & key points
The directive 'outline' demands structured, systematic presentation of facts across all sub-parts. Allocate approximately 40% time/words to part (a) [20 marks], 40% to part (b) [20 marks], and 20% to part (c) [10 marks]. Structure: Begin with direct identification of hypothyroidism in (a)(i), followed by tabulated cardiovascular comparison, then pharmacological management with monitoring protocols; for (b), present IMNCI assessment criteria in algorithmic format with clear classification and treatment protocols; for (c), provide differential diagnosis with Stevens-Johnson syndrome as primary, followed by immediate management steps. Use tables for comparisons and bulleted lists for protocols to enhance clarity.
- Part (a)(i): Correct identification of primary hypothyroidism (Hashimoto's thyroiditis most likely in 25-year-old female) with brief justification based on clinical triad
- Part (a)(ii): Comprehensive tabular comparison of cardiovascular manifestations: hypothyroidism (bradycardia, diastolic hypertension, decreased cardiac output, pericardial effusion, hypercholesterolemia) versus hyperthyroidism (tachycardia, systolic hypertension, increased cardiac output, high-output failure, atrial fibrillation)
- Part (a)(iii): Pharmacological management—levothyroxine for hypothyroidism (dosing, titration); carbimazole/methimazole, propylthiouracil, radioiodine, surgery for hyperthyroidism; monitoring via TSH (primary), FT4, FT3 with target ranges
- Part (b): IMNCI assessment using main symptoms (convulsions, fast breathing, severe chest indrawing, nasal flaring, grunting, bulging fontanelle, pus discharge from ear, umbilical redness, skin pustules, lethargy, reduced feeding, fever/low body temperature); classification criteria for PSBI versus local infection; treatment protocols including referral, antibiotics (ampicillin + gentamicin), supportive care
- Part (c): Differential diagnosis prioritizing Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum (lamotrigine-induced), DRESS syndrome, bullous pemphigoid; management emphasizing immediate drug withdrawal, supportive care, IV fluids, infection prevention, ophthalmology referral, role of corticosteroids
Q5 50M Compulsory outline Clinical medicine and surgery
(a) (i) Name the clinical tests for checking sapheno-femoral junction competence and deep venous system patency.
(ii) Enumerate the complications of varicose veins.
(iii) Briefly discuss the management of venous ulcer. 2+4+4=10
(b) A 65 year old male came to casualty with acute retention of urine. He also gave history of nocturia, urgency, dribbling and thin stream of urine for two years.
(i) How will you manage acute retention of urine in this patient ?
(ii) Briefly outline the definitive management in this patient. 4+6=10
(c) Outline the management of a 35 year old multigraveda patient who has presented to the emergency department in a state of shock. She has delivered a dead baby at home 2 hours back and the placenta has not delivered. She has a previous history of lower segment caesarean section. 10
(d) (i) Enumerate the contraindications which limit the usage of oral contraceptive pills in a woman.
(ii) Discuss the causes for failure of sterilization procedure in males and in females. 5+5=10
(e) State the National Guidelines on feeding of infant and young child. What are the goals which these guidelines strive to achieve ? 5+5=10
Answer approach & key points
The directive 'outline' demands a structured, systematic presentation of management protocols and clinical reasoning across all five parts. Allocate approximately 20% (10 marks) each to parts (a), (b), (c), (d), and (e), with sub-parts weighted by their mark distribution—e.g., within (a), spend roughly 20% on (i), 40% on (ii), and 40% on (iii). Structure each part as: clinical assessment → diagnostic approach → management steps → complications/prevention. For (e), explicitly cite IAP/NNF or MoHFW guidelines with specific goals like reducing under-5 mortality and malnutrition.
- For (a)(i): Name Trendelenburg test (for SFJ competence) and Perthes test/MODIFIED Perthes test (for deep venous patency); for (a)(ii): List complications—venous eczema, lipodermatosclerosis, ulceration, thrombophlebitis, bleeding; for (a)(iii): Management of venous ulcer—compression therapy (4-layer bandaging), limb elevation, wound debridement, pentoxifylline, skin grafting if needed
- For (b): Acute retention management—urethral catheterization (first attempt), suprapubic catheter if failed; rule out urethral stricture; definitive management—TURP (gold standard for BPH), open prostatectomy if gland >80g, medical therapy (alpha-blockers, 5-ARIs) for poor surgical candidates
- For (c): Postpartum hemorrhage from retained placenta with scarred uterus—resuscitation (IV fluids, blood transfusion), manual removal of placenta under anesthesia, ultrasound to confirm completeness, hysterectomy if placenta accreta/increta with scar rupture, antibiotics and uterotonics
- For (d)(i): OCP contraindications—age >35 with smoking, migraine with aura, history of thromboembolism, breast/liver cancer, severe hypertension, active liver disease, lactation (estrogen-containing pills); for (d)(ii): Female sterilization failure—recanalization, fistula formation, wrong structure ligated; male—recanalization, technical error (incomplete occlusion), spontaneous reanastomosis
- For (e): National guidelines—IYCF (Infant and Young Child Feeding) 2016, early initiation within 1 hour, exclusive breastfeeding 6 months, complementary feeding 6-24 months, continued breastfeeding 2 years; Goals—reduce neonatal mortality, prevent malnutrition, reduce stunting/wasting, improve cognitive development, achieve 90% institutional delivery and early breastfeeding
Q6 50M describe Obstetrics, tuberculosis and epidemiology
(a) Define 'pre-eclampsia'. Enumerate the risk factors which may lead to this condition. What are its clinical signs and what are its alarming symptoms ? Outline in brief its management. 3+5+6+6=20
(b) Describe clinical features, diagnosis and management of ileo-caecal tuberculosis. 5+5+5=15
(c) (i) What are the objectives of investigating an epidemic ?
(ii) Briefly state the various steps you would undertake while investigating an epidemic. 5+10=15
Answer approach & key points
The directive 'describe' demands comprehensive, structured coverage of clinical entities and processes across all four sub-parts. Allocate approximately 40% of time/words to part (a) given its 20 marks, 30% to part (b) for 15 marks, and 30% combined to (c)(i) and (c)(ii) for 15 marks. Structure as: (a) definition → risk factors → clinical signs → alarming symptoms → management; (b) clinical features → diagnosis → management; (c) objectives → systematic investigation steps. Use Indian epidemiological data (e.g., NFHS-5 for maternal health, RNTCP for TB, IDSP for outbreak investigation) throughout.
- Part (a): Precise definition of pre-eclampsia (new-onset hypertension + proteinuria after 20 weeks); risk factors include nulliparity, chronic hypertension, multiple gestation, renal disease; clinical signs (BP ≥140/90, proteinuria, edema); alarming symptoms (headache, visual disturbances, epigastric pain, hyperreflexia); management per FIGO/WHO guidelines with antihypertensives, magnesium sulfate, delivery timing
- Part (b): Ileo-caecal TB features (abdominal pain, mass, obstruction, alternating constipation-diarrhea); diagnosis via colonoscopy with biopsy (caseating granulomas), CT/MRI showing 'comb sign', ascitic fluid ADA, GeneXpert MTB/RIF; ATT regimen per RNTCP (2HRZE/4HRE) with surgery for complications
- Part (c)(i): Epidemic investigation objectives: verify diagnosis, determine extent, identify source/mode of transmission, implement control, formulate hypotheses, train personnel
- Part (c)(ii): Systematic steps: prepare for field work, establish existence of epidemic, verify diagnosis, define and count cases, orient data by person/place/time, formulate/test hypotheses, implement control measures, communicate findings (reference IDSP outbreak response protocol)
- Integration: Application of Indian public health frameworks (RNTCP, IDSP, MCP) and recent epidemiological data (e.g., rising TB-DM comorbidity, maternal mortality trends)
Q7 50M enumerate Gallbladder disease, iron metabolism, HRT
7.(a) A 40 year old lady came to casualty with pain in the right upper abdomen associated with vomitings for 5 days. On examination, she was found to be having tenderness in right hypochondrium; the rest of the abdomen was normal. Ultrasound abdomen revealed a thick walled gallbladder with gall stones and pericholecystic fluid.
(i) What is the clinical diagnosis and how will you manage this condition ? (6 marks)
(ii) Enumerate the complications of gall stones. (6 marks)
(iii) What is Mirizzi Syndrome ? How would you investigate and manage it ? (8 marks)
7.(b) (i) What is the total content of iron in the human body ? (2 marks)
(ii) What are its bodily functions ? (4 marks)
(iii) State the interventions being undertaken under the 'Anaemia Mukt Bharat Strategy'. (9 marks)
7.(c) (i) What is the current consensus on prescribing Hormone replacement therapy (HRT) in post menopausal women ? (10 marks)
(ii) Discuss its merits and demerits. (5 marks)
Answer approach & key points
The directive 'enumerate' demands systematic listing with brief elaboration. Structure: (a) Acute cholecystitis diagnosis with Tokyo guidelines mention, complications in anatomical sequence, Mirizzi with Csendes classification; (b) Iron distribution with diagram, functions categorized, Anaemia Mukt Bharat 6x6x6 strategy; (c) HRT current consensus per NAMS/IMS guidelines, merits/demerits balanced. Allocate ~40% time to 7(a) [20 marks], ~35% to 7(c) [15 marks], ~25% to 7(b) [15 marks].
- 7(a)(i): Diagnosis of acute calculous cholecystitis per Tokyo Guidelines 2018 (TG18) with Murphy's sign, ultrasound findings; management—IV antibiotics (ceftriaxone + metronidazole), analgesia, early laparoscopic cholecystectomy vs. delayed based on severity
- 7(a)(ii): Complications classified as intra-luminal (mucocele, empyema), extra-luminal (perforation, peritonitis, abscess), fistulous (cholecystoenteric, gallstone ileus), and malignant (GB cancer)
- 7(a)(iii): Mirizzi syndrome Type I (extrinsic compression) vs Type II-IV (fistula) per Csendes classification; investigation—MRCP (gold standard), ERCP; management—open surgery, subtotal cholecystectomy, Roux-en-Y hepaticojejunostomy for Type IV
- 7(b): Total body iron 3-4g (men) / 2-2.5g (women); 65% in Hb, 30% stores (ferritin/hemosiderin), 5% myoglobin/enzymes; functions—oxygen transport, electron transport (cytochromes), DNA synthesis (ribonucleotide reductase), immune function
- 7(b): Anaemia Mukt Bharat 6 interventions—IF supplementation, deworming, delayed cord clamping, dietary diversification, fortified foods, screening; 6 target groups—children, adolescents, women, pregnant/lactating; 6 institutional mechanisms
- 7(c): Current HRT consensus—'window of opportunity' (age <60 or <10 years post-menopause), transdermal estradiol preferred, lowest effective dose, individualized risk assessment; contraindications—VTE, breast cancer, CVD, stroke, liver disease
- 7(c): Merits—vasomotor symptom relief, osteoporosis prevention, urogenital atrophy improvement, possible cognitive benefit if early initiation; demerits—VTE risk (RR 2-3), breast cancer (RR 1.2 with >5 years use), stroke, gallbladder disease
Q8 50M discuss End TB Strategy, HPV vaccination, breast cancer
8.(a) The 'End TB Strategy' is an evolution over the previous strategies to win over tuberculosis.
(i) What are the key principles of the 'End TB Strategy' ? (4 marks)
(ii) What are the 'pillars and components' of this strategy ? (10 marks)
(iii) What are the major barriers that have thwarted the progress in the battle against the disease ? (6 marks)
8.(b) (i) What has been the impact of HPV vaccination in India ? (7½ marks)
(ii) Discuss the currently available Human Papilloma Virus (HPV) Vaccines and their schedules. (7½ marks)
8.(c) A 60 year old lady comes to surgery OPD with 6×4 cm lump in her right breast with nipple discharge.
(i) What will be the possible findings on clinical examination if this lump were to be malignant ? (6 marks)
(ii) How will you investigate this patient ? (6 marks)
(iii) What are the important structures which are to be preserved during modified radical mastectomy ? (3 marks)
Answer approach & key points
The directive 'discuss' demands a comprehensive, analytical treatment across all sub-parts. Allocate approximately 40% of time/words to 8(a) End TB Strategy (20 marks), 30% to 8(b) HPV vaccination (15 marks), and 30% to 8(c) breast cancer case (15 marks). Structure: begin with WHO End TB Strategy principles and pillars, transition to HPV vaccines with Indian context (SIIP, Tamil Nadu pilot), conclude with systematic breast cancer workup and MRM anatomy.
- 8(a)(i-iii): End TB Strategy principles (SDG alignment, patient-centered care), three pillars with 13 components, barriers (MDR-TB, stigma, COVID-19 disruption, funding gaps)
- 8(b)(i): India-specific HPV impact data—Tamil Nadu demonstration project, SIIP inclusion, coverage challenges, potential for cervical cancer reduction
- 8(b)(ii): Bivalent (Cervarix: 0, 1-2, 6 months), Quadrivalent (Gardasil: 0, 2, 6 months), Nonavalent (Gardasil 9: same schedule); age groups 9-14 vs 15-26; 2-dose vs 3-dose schedules
- 8(c)(i): Malignant breast lump features—hard, irregular, fixed, skin dimpling/peau d'orange, nipple retraction, bloody discharge, axillary lymphadenopathy
- 8(c)(ii): Triple assessment—clinical examination, imaging (mammography/USG/MRI), cytology/histology (FNAC/core biopsy); receptor status (ER/PR/HER2)
- 8(c)(iii): MRM preservation—pectoralis major, pectoralis minor (or only major in Patey modification), long thoracic nerve (serratus anterior), thoracodorsal nerve (latissimus dorsi), intercostobrachial nerve