High yield
What is the Jarisch-Herxheimer reaction
Self-limiting fever, rigors and hypotension within 24 h of antibiotics for spirochaetes; mimics sepsis and septic shock.
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
26. Maxillofacial injuries
Open and closed injuries of the face and jaws; airway first, then mandible, Le Fort, zygomatic and orbital fractures.
High yield
27. Maxillofacial inflammation and tumours
Odontogenic abscess, Ludwig's angina, sialadenitis and jaw osteomyelitis; salivary and oral tumours, mostly squamous cell carcinoma.
High yield
28. Congenital, traumatic and inflammatory diseases of the neck
Thyroglossal and branchial cysts, lymphatic malformations, penetrating neck trauma by zones, lymphadenitis and deep neck abscesses.
High yield
29. Neck tumours and tracheostomy
Neck lumps by age and site, benign and malignant tumours; tracheostomy types, indications, steps and complications.
High yield
30. Goitre and special forms of goitre
Enlargement of the thyroid; diffuse or nodular, toxic or non-toxic; retrosternal goitre and thyroiditis are the special forms.
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.
Basis cranii: the cerebral fossae
The anterior, middle and posterior cranial fossae and what passes through them.
High yield
The abdominal aorta
Leaves through the aortic hiatus at T12 and supplies every abdominal organ.
Celiac trunk
Supplies the stomach, liver, pancreas, spleen and the first two parts of the duodenum, at T12.
Superior mesenteric artery
The artery of the midgut, from the third part of the duodenum to the proximal transverse colon.
Inferior mesenteric artery
The artery of the hindgut. Arises at L3 and runs slightly to the left of the aorta.
External iliac artery
Continues as the femoral artery and gives off the inferior epigastric and deep circumflex iliac arteries.
Internal iliac artery
The main artery of the pelvis, its anterior and posterior divisions and their branches.
Liver blood supply and drainage
The liver’s dual blood supply: the hepatic artery brings about 25% of the flow, the portal vein the rest.
Popliteal fossa
The diamond-shaped space behind the knee, home of Baker’s cysts. Key to safe access to the knee joint.
Morrison’s pouch
The hepatorenal pouch: a potential space between the liver and right kidney in the supramesocolic compartment.
High yield
Calot’s triangle
Dissected in every cholecystectomy. Identify the cystic artery and duct before dividing them.
Cantlie’s line: a brief overview
The plane that divides the liver into functional left and right lobes, central to hepatectomy.
Named fascial layers
Every fascia named after a person. Essential for oral exams in surgery and anatomy.
Layers in a chest drain insertion
The layers you pass through when placing a chest drain for haemothorax, pneumothorax or effusion.
Layers in a lumbar puncture
From the skin to the subarachnoid space, layer by layer.
Layers in a C-section
Every layer involved in a caesarean section, from the skin downwards.
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.
New
The practical section of the surgery state exam
High-yield tips for the practical section of the surgery state exam at MU Pleven.