Surgery
High yield
1. Injuries: definition and classification
Tissue damage from an external agent exceeding tissue resistance; classified by agent, skin integrity, cavity, number and severity.
High yield
Stomach: surgical anatomy
J-shaped foregut organ from the cardia (T11) to the pylorus (L1); antrum lacks parietal and chief cells.
High yield
2. Closed mechanical injuries
Mechanical injuries with intact skin: contusion, haematoma, sprain, dislocation, subcutaneous rupture, concussion and compression.
High yield
Blood supply of the stomach
Five named arteries from the coeliac trunk form lesser and greater curvature arcades; veins drain to the portal system.
High yield
3. Open injuries (wounds)
Breach of skin or mucosa by a mechanical agent; three damage zones; types by agent and contamination.
High yield
Vagal innervation of the stomach
Anterior (left) and posterior (right) vagal trunks give hepatic, coeliac and gastric divisions; nerves of Latarjet supply the antrum.
High yield
4. Thermal burns
Heat injury graded by depth and extent; burn disease runs through shock, toxaemia, septicotoxaemia and convalescence.
High yield
Duodenum: surgical anatomy
C-shaped, 25–30 cm, from pylorus to duodenojejunal flexure around the pancreatic head; retroperitoneal except the first 2.5 cm.
High yield
5. Electrical injury
Current through the body causes heat damage along its path, arrhythmias and rhabdomyolysis; the skin hides deep injury.
High yield
Blood supply of the duodenum
Anterior and posterior pancreaticoduodenal arcades join the gastroduodenal artery (coeliac) to the superior mesenteric artery.
High yield
6. Frostbite
Freezing injury from ice crystals and microvascular thrombosis; four degrees; rapid rewarming at 37–39 °C, late amputation.
High yield
Lymphatic drainage of the stomach and duodenum
Gastric lymph follows the arteries through 20 numbered stations to the coeliac nodes; duodenal lymph drains to pancreaticoduodenal nodes.
High yield
7. Haemostasis
Spontaneous haemostasis by spasm, platelet plug and clotting; artificial haemostasis is temporary or definitive.
High yield
Kocher manoeuvre
Peritoneum lateral to the second part of the duodenum incised; duodenum and pancreatic head reflected medially off the IVC.
High yield
8. Wound healing
Healing runs through haemostasis, inflammation, proliferation and remodelling; by primary, secondary or tertiary intention to a scar.
High yield
9. Wound treatment and primary surgical treatment
Primary surgical treatment turns a contaminated wound into a clean one; closure is primary, delayed primary or secondary.
High yield
10. Blood transfusion and blood groups
ABO and Rh groups decide compatibility; group, screen, crossmatch and bedside checks before transfusion; haemolysis is the worst complication.
High yield
11. Blood products and blood substitutes
Red cells, platelets, plasma and cryoprecipitate replace specific deficits; crystalloids and colloids restore volume.
High yield
12. Postoperative period and complications
Postoperative care and observation, and complications classified by time, system and Clavien-Dindo grade, with prevention and treatment.
High yield
13. Shock
Circulatory failure causing inadequate tissue perfusion and oxygenation; hypovolaemic, cardiogenic, obstructive or distributive.
High yield
14. Acute purulent infection
Pyogenic bacteria entering through skin or mucosa cause local suppurative inflammation and a systemic response.
High yield
15. Hot abscess
Localised collection of pus walled off by a pyogenic membrane; fluctuation, systemic signs; treated by incision and drainage.
High yield
16. Phlegmon
Diffuse purulent inflammation spreading through tissue planes without a limiting wall; wide incision, drainage and antibiotics.
High yield
17. Osteomyelitis
Bone infection by haematogenous, contiguous or post-traumatic spread; acute disease evolves to sequestrum and chronic infection.
High yield
18. Erysipelas
Streptococcal infection of the dermis and superficial lymphatics; bright red plaque with a sharp raised border; penicillin.
High yield
19. Tetanus
Clostridium tetani toxin blocks inhibitory neurones, causing trismus, rigidity and spasms; prevented by toxoid and immunoglobulin.
High yield
20. Sepsis and SIRS
Dysregulated host response to infection causing organ dysfunction; SIRS, sepsis, septic shock; source control and the 1-hour bundle.
High yield
21. Anaerobic gas infection
Clostridial myonecrosis in devitalised muscle; toxins cause gas, oedema, necrosis and shock; radical debridement and penicillin.
High yield
22. Necrosis and gangrene
Tissue death in a living body; dry gangrene mummifies and demarcates, wet gangrene putrefies and spreads.
High yield
23. Ulcers
Chronic skin or mucosal defect with no tendency to heal; mainly venous, arterial, neuropathic or pressure ulcers.
High yield
24. Fistulas
Abnormal communication between two epithelial surfaces; congenital or acquired, external or internal; FRIENDS factors prevent closure.
High yield
25. Cleft lip and cleft palate
Failed fusion of facial processes causes cleft lip and cleft palate; staged repair by a cleft team.
High yield
58. Peptic ulcer: modern surgical treatment
Mucosal defect beyond the muscularis mucosae from acid-pepsin; H. pylori and NSAIDs cause most; surgery mainly for complications.
High yield
60. Perforated peptic ulcer
Gastric or duodenal ulcer perforating into the peritoneum; resuscitation, omental patch repair and H. pylori eradication.
High yield
61. Bleeding peptic ulcer
Commonest cause of upper gastrointestinal bleeding; endoscopic dual therapy and PPI first; surgery or embolisation if endoscopy fails.
High yield
Acute appendicitis
A surgical emergency. Early recognition and prompt surgery prevent perforation and peritonitis.
Open appendectomy
A step-by-step guide to an open appendectomy.
Peritonitis
Causes, presentation and management of inflammation of the peritoneum.
Set-back suture technique
How to place a set-back dermal suture, and when to use it.
Bowel preparation: a review
A comprehensive review of bowel preparation for clinical practice.
Bowel preparation options in Bulgaria
Every bowel preparation available in Bulgaria in one clear chart.
Ranson’s criteria explained
A prognostic score for the severity and mortality of acute pancreatitis.
Carnett’s sign
Tells abdominal wall pain apart from pain arising inside the abdomen.
Emergency medical preparedness in India
A practical preparedness guide for emergencies, written for the Indian context.
Tumours: definition, classification and tumorigenesis
State exam topic 33: how tumours are defined and classified, and the theories of how they form.
Benign tumours of epidermal and mesenchymal origin
State exam topic 34: benign epidermal and mesenchymal tumours and the principles of treatment.