Syllabus |
Note the menu to the left of your page for quick links, or scroll down to browse The following currriculum is incomplete but offers an insight inot the broad spectrum of questions you may get asked and tips on what you should cover in your reading. Although it is divided into
MCQ's cover all topics in these categories. This is a general exam and you need to cover the topics in other areas to be assured of success. So if you are a Breast surgeon you still need to read up on transplantation, upper GI and colorecatal topics.....even the ones in the subspecialty section of the currriculum!!! The depth of knowledge is inconsistent, so don't shoot the messenger. Links are provided where the subject has been covered.
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This is workin progress
Emergency and Critical care
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ATLS |
********Know your ATLS book. Do not skimp on this subject******* e.g Triage – there is a standard guide apparently |
Assessment of the acute abdomen |
80 yr female presents with abdominal pain and bloody diarrhoea. AF and acidosis
24 Year old woman with RIF pain. What would you do?
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Perorated peptic ulcer |
How would you manage the simple small perforation? Have an answer about the large DU or gastric ulcer you can’t close primarily. If you had to do a gastrectomy do you know which vessels you would divide? LOOK IT UP!! H Pylori- do you know how to test fo it and how the tests work? |
Biliary tract emergencies |
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Acute pancreatitis |
http://www.wmsurgeons.com/kb/entry/71/ Serum lipase READ the BSG guidelines |
Swallowed foreign bodies |
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Gastrointestinal bleeding |
Upper GI bleed. Don’t forget massive lower GI bleeding |
Appendicitis and right iliac fossa pain |
Appendix mass….have you got a coherent management strategy? |
Abdominal pain in children |
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Acute intestinal obstruction |
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Intestinal pseudo-obstruction |
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Strangulated hernia |
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Intestinal ischaemia |
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Superficial sepsis and abscesses |
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Acute ano-rectal sepsis |
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Ruptured aortic aneurysm |
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Acutely ischaemic limb |
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Acute presentations of urological disease |
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Acute presentations of gynaecological disease |
Differential in a young woman with lower abdominal pain |
Scrotal emergencies in all age groups |
Clinical presentation and management of scrotal conditions. |
Assessment of the multiple injured patient including children |
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Closed abdominal injuries, especially splenic, hepatic and pancreatic injuries |
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Closed chest injuries |
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Stab and gunshot wounds |
Small bowel injury on laparotomy following stab wound (1 cm hole mid ileum) with contamination.
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Arterial injuries |
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Injuries of the urinary tract |
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Common gynaecological problems |
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Hypotension |
Post operative scenarios |
Haemorrhage |
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Blood and coagulation |
You will need some general knowledge on haemorrhagic and thrombotic disorders, blood transfusion and blood component therapy |
SIRS, Sepsis and septic shock |
http://www.wmsurgeons.com/kb/entry/25/ Vasopressor agents, which one? http://www.wmsurgeons.com/kb/entry/43/ |
Antibiotic therapy and the management of opportunist infection |
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Gastro-intestinal fluid losses and fluid balance, including in children |
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Nutritional failure and nutritional support |
Enteral / parenteral nutrition: This topic appears in the Emergency Companion Series. If anyone has a summary I could post it. Could you say how and justify routes of nutrition in these circumstances( i.e TPN via CVP / Hickmann line, Peripheral TPN, Enteral, jejunal ?
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Respiratory failure |
Respiratory failure come up again and again |
Renal failure and principles of dialysis |
Could you give the indications for dialysis? http://www.wmsurgeons.com/kb/entry/44/ You also need to know the principles of dialysis |
Fluid overload and cardiac failure |
What is the cardiac index? |
Myocardial ischaemia |
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Cardiac arrythmias |
Atrial myxoma- what are the clinical features e.g AF & embolisation http://www.emedicine.com/med/topic186.htm |
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Multiple organ failure |
In the context on septic shock |
Pain control |
Post operative pain relief |
Cardiac arrest, respiratory arrest and brain death |
DO YOU KNOW HOW TO DO CPR? |
Organ donation |
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Hypo and hyperthermia |
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Diagnosis of brain death |
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Legal & ethical aspect of transplantation |
If there is anything you need to know....PLEASE know this like your best local pub. It is frequented many, many times in the exam |
prolonged PR intervalCore General
Carcinoma of the breast |
What would you do with the axilla in a patient with DCIS? Staging Staging and prognosis
Nottingham prognostic index- you might want to have an idea of how you would calculate this index. And I mean you may want to memorise it because you may need it one day. http://www.wmsurgeons.com/kb/entry/68/ Know your genes
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Screening |
Screening is topical and it is worth knowing about all the specialties of screening. Here is a link for the NHS Breast Screening web site. Useful links to important guidelines are available on the right hand sied of the page. http://www.cancerscreening.nhs.uk/breastscreen/index.html |
Benign breast disease |
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Hormone therapy for benign and malignant breast disease |
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Histo-/cytopathology |
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Mammography |
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Ultrasound |
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Adjuvant chemotherapy: |
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Chemotherapy for advanced disease |
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Radiotherapy |
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Counselling |
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Hospice care |
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Symptoms |
Know and justify the steps you would do to investigate
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Inflammatory bowel disease (inc medical management) |
How would you investigate someone with diarrhoea – i.e differentiating infection / crohns/ and UC what are the clinical / histological (macro / microscopic) features? |
Diverticular disease |
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Irritable bowel syndrome |
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Perianal conditions |
A man comes with a tender mass at the anal verge of 3 days duration. He reports constipated. Diagnosis?
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Haemorrhoids |
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Anal fissure |
Know your treatments |
Rectal prolapse |
http://www.wmsurgeons.com/kb/entry/162/ |
Fistula in ano |
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Diverticular disease/fistula |
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Intestinal fistula |
The general principles of management are important |
Colostomy complications |
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Ileostomy complications |
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Anaemia |
What are the different causes? Common problem. How would you investigate and manage… think beyond your everyday practice……you do your OGD and Barium…they are normal what next? Know the BSG guidelines |
Lymphoma |
How this presents and complications of lymphoma. |
Carcinoid disease |
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Physiology & pathology of:-Thyroid |
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Thyroid gland |
Thyroid lump – do you know the principles of management? Medullary thyroid cancer - http://www.wmsurgeons.com/kb/entry/127/ Uses of recombinant TSH have important clinical applications
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Parathyroid |
Hyper parathyroidism – diagnosis, preoperative imaging and treatment of primary, secondary and tertiary disease |
Adrenal cortex |
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Adrenal medulla |
Phaeochromacytoma - http://www.wmsurgeons.com/kb/entry/51/ |
Thyrotoxicosis |
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Adrenal insufficiency |
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Hyper and hypo thyroidism |
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MEN |
Know you genes - http://www.wmsurgeons.com/kb/entry/34/ |
Imaging techniques for endocrine organs |
For example partathyroid imaging http://www.wmsurgeons.com/kb/entry/178/
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Endocrine links |
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Skin cancers |
Remind yourselves of the appearance, staging, and treatment of common skin cancers. For example could you give the most likely answer for a suspected skin lesion on the…
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Gastrointestinal Bleeding |
Know the guidelines and what you would do for Bleeding secondary to an ulcer Know your operations for dealing with emergency perforated peptic ulcers!! For example what YOU would do for a large duodenal / gastric ulcer that you were unable to close or patch. And the answer is never ‘I would ask my Upper GI colleagues to deal with it’. YOU should have a clear answer on how YOU would deal with it if you had to. |
Gallstone disease |
Atypical questions get asked. E.g Mirizzi syndrome, CBD injuries |
Jaundice |
Management of CBD stones – needs a succinct summary Variations on theme. For example.
Pick one. You’ll have to in the exam.
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Gastro-oesophageal reflux and its complications |
Barretts oesophagus – you find it what would you do with it? http://www.wmsurgeons.com/kb/entry/167/ Deemester score: http://www.emedicine.com/radio/topic300.htm |
Hiatus hernia |
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Neoplasms of the upper GI tract |
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Obesity |
Fundamentals of obesity surgery, including Roux Loop length |
Swallowing difficulties |
Do you know how to differentiate swallowing difficulties- spasm, achalasia, esophagitis? |
Drugs |
Know you drugs used to treat Upper GI conditions ( how they work and what are their indications) e.g octreotide, verapamil, gaviscon |
Hernias. |
A topic you think you know but in fact you don’t. What nerves can you injury during groin surgery? Then there are the tricky questions. For example
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Hernia in childhood |
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Testicular tumours |
Know your classification, clinical presentation, staging and a rough idea on how to treat each type |
Symptoms |
Note that some questions ask about symptoms. For example:
b) Investigation of a swollen leg
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Atherosclerosis |
Could you tell the difference between different types of leg pain? E.g claudication vs spinal claudication? http://www.wmsurgeons.com/kb/entry/75/ Investigation of these patients Carotid disease. When to operate? |
Ischaemic limb |
Acute loss of arterial or venous flow. For example I may be trapped in the kneeling position for 6 hours….what is my likely neuro-vascular deficite? |
Aneurysmal disease |
EVAR 1and 2 http://www.wmsurgeons.com/kb/entry/66/ Popliteal aneurysm. 1.5cm in a 70 year old man with normal pulses and claudiction
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Venous thrombosis & embolism |
NICE issued guideline in May 2007. You need to read them |
Hyper-hypo coagulable state |
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Chronic venous insufficiency |
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Arteriography |
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Vascular CT scanning |
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Magnetic Resonance Angiography |
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Vascular ultrasound |
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Varicose veins |
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Mesenteric ischaemia |
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Nerve injury |
What nerves injuries can occur during different types of surgery /trauma?
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Lumps in the neck |
You need to know this inside out. It comes up throughout the exam. For example. You see a man with a pre auricular 1 cm firm lump. How would you investigate him?
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Cervical rib / Thoracic outlet syndrome |
Do you know the symptoms, what nerves are affected, what happens when vascular compromise occurs. Clinical examination techniques and management? |
Tracheostomy |
What types, indications, surgical technique and complications. |
Symptoms |
Questions relate to symptoms. For example EMI may ask about RUQ pain
Some questions are sensible. Some may be like this one in which more than one answer is possible and you just have to guess. |
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Post operative complications |
Some questions ask about hypotension post op. Useful to have a snappy answer for this for the vivas. Some may be very specific and you may be asked what would be the next appropriate management step. Some require surgery some investigation in the first instance
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Anaemia |
What are the different causes? Common problem. How would you investigate and manage… think beyond your everyday practice……you do your OGD and Barium…they are normal what next? Know the BSG guidelines |
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Renal disease |
Know your renal physiology- what gets absorbed and where. http://en.wikipedia.org/wiki/Renal_physiology What problems do renal failure patients http://www.wmsurgeons.com/kb/entry/98/ |
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Drugs |
Local anaesthetics – know your safe doses Anti emetics. Do you know how they work? |
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Nutrition |
Enteral / parenteral nutrition: This topic appears in the Emergency Companion Series. If anyone has a summary I could post it. |
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Fluid management |
Do you really know how to manage fluids post operatively. What fluids to give, what they contain….etc |
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GIST’s |
Gastro intestinal stromal tumours. |
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Carcinoid |
This can appear anywhere in the GI tract |
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Tumour markers |
Know applications of these |
CA15-3 |
Radiation injury |
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Critical appraisal of the surgical literature |
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Scientific method & statistics as applied to surgery |
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Informed consent |
Consent- http://www.library.nhs.uk/theatres/ViewResource.aspx?resID=259250#legal |
Ethical aspects of surgical practice |
For example while under an anaesthesia you get unexpected bleeding in a child of 12 who is a jehovah’s witness- are you legally allowed to transfuse? |
Genetic aspects of surgical disease |
Know you genes - http://www.wmsurgeons.com/kb/entry/34/ |
Clinical governance |
Clinical governance. Would you know what to do if your FY2 with previous blameless record administers 100 times the dose of required insulin and patient dies |
Oddities |
Klippel trenaunay syndrome - This is a very important condition that you must know about as you may see it once every 100 years http://www.emedicine.com/derm/topic213.htm Nerological manaifestations of surgical conditions |
Embryology |
Some topics come up that you should have read about Embryological remnants that present in adult life…..think http://www.wmsurgeons.com/kb/entry/160/ Diaphramatic hernia
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General facts |
You should be aware of general health facts:
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Gynaecology need to know basis |
Some general facts regarding gynaecological problems may be useful to know. These include:
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General radiology signs |
When would you see…. |
Levels of evidence |
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Parametric and non parametric tests |
Do you know the difference? |
Physiology of pneumo-peritoneum |
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Informed consent for laparoscopic procedures |
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Pre and post operative management of laparoscopic cases |
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Port complications |
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Technology of video imaging, cameras, insufflator etc |
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Laparoscopic instruments, clips, staplers and port types |
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Management of equipment failure |
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Recognition and management of laparoscopic complications |
Hypotension post lap chole + abdo pain and hypotension, tachypnoea. Could you formulate a management plan and differential diagnosis? |
Use and dangers of diathermy |
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Anaesthetic problems in laparoscopic surgery |
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Subspecialty
Hint: Know the 2007 ACPGBI guidelines. You will need to know them for the vivas and clinicals if you are colorectal declared. If not scroll through the type of questions covered in this section below. |
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Anal tumours |
Anal cancer management is given in this document. For example:
Answer: chemoradiotherapy |
Pelvic autonomic nerves |
Now then. Can you give an account of the origin, course and supply of the pelvic autonomic nerves? Where might these be damaged during an anterior resection, and what are the likely effects? |
Symptomatic patients |
What are the referral guidelines for CRC? |
Screening for colorectal cancer |
These can be divided inot the asymptomatic and symptomatic Asymptomatic – i.e The national screening program How does FOB work? http://www.wmsurgeons.com/kb/entry/14/ Symptomatic – |
Genetics of colorectal cancer |
Know your genes |
Place of radiotherapy and chemotherapy in treatment |
Rectal cancer – huge topic but know….. |
Anorectal physiology |
The Dukes club have a powerpoint presentation on this I found useful Download link below here |
Anorectal ultrasound |
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Faecal incontinence |
Wexner score – commit the table to memory http://www.wmsurgeons.com/kb/entry/81/ |
Chronic constipation |
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Complex intestinal fistulae |
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Colonic bleeding |
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Radiation enterocolitis |
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Other small bowel conditions |
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Rectal Carcinoma |
Have a rough idea of leak rates http://www.wmsurgeons.com/kb/entry/1/ How would a leak present post op and what would you do? |
Colonic carcinoma |
Have a rough idea of leak rates http://www.wmsurgeons.com/kb/entry/1/ |
Genetics related to surgery |
Know your genes http://www.wmsurgeons.com/kb/entry/34/ |
Immunocyto-chemistry |
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Clinical trials |
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Neo-adjuvant therapy and related surgery |
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Epidemiology |
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Screening programme |
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Stereotaxis |
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Epidemiology and aetiology of oesophago-gastric, pancreato-biliary and liver cancer |
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Principles of screening for cancer |
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Upper GI cancer |
Symptoms of dysphagia – investigation of patient Staging preoperatively of oesophageal cancer Having staged the cancer T2 N0 M0 tumour of the esophagus
Staging of gastric cancer Gallbladder cancer Principles of gastric cance surgery. What complication may arise from a patient who is post op from and Ivor Lewis resection? E.g a chyle leak may require some thought. |
Oesophageal motility disorders |
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Imaging and endoluminal ultrasound |
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Chronic pancreatitis |
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Complex liver injuries |
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Liver cysts and Hydatid disease |
You find a liver abscess what are the most likely organisms? |
Management of primary & secondary hepatic and choledochal neoplasms |
Choledochal cysts: |
Pancreatic neoplasms |
Principles of investigation and management. What do they do in a Whipples procedure? What joins to what? |
Chronic liver disease |
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Liver failure |
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Pancreatic insufficiency |
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Imaging & endoluminal ultrasound |
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Hepatitis |
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Pathology of renal and hepatic disease |
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Patho-physiology of renal and hepatic failure |
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Peritoneal and haemo-dialysis |
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Selection of patients for transplantation |
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Post-operative management |
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Immuno-pathology of rejection |
What are the types of rejection? http://www.wmsurgeons.com/kb/entry/139/ |
Management of rejection |
You should have the types of rejection clear in your mind |
Immunosuppression |
A few drugs are worth knowing. |
Opportunist infections |
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Immunosuppression and cancer |
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Transmission of viral and fungal diseases |
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Tissue typing |
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The HLA system |
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Legal & ethical aspects of transplantation |
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