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Clinical Surgery Syllabus

The Surgery syllabus for Clinical in full: 9 chapters, 32 topics and 98 sub-topics, every one listed below, plus 50 Surgery flashcards with answers.

9Chapters
32Topics
98Sub-topics
50Flashcards

Surgery syllabus: all 9 chapters

Expand any chapter to see its topics and sub-topics.

  1. General Surgery

     4 topics
    • Preoperative Care
      • Patient Assessment
      • Risk Stratification
      • Preoperative Investigations
      • Informed Consent
    • Postoperative Care
      • Monitoring and Support
      • Pain Management
      • Wound Care
      • Complications and Management
    • Surgical Infections
      • Types of Infections
      • Antibiotic Prophylaxis
      • Management of Surgical Site Infections
    • Surgical Techniques
      • Aseptic Techniques
      • Suturing and Knot Tying
      • Hemostasis

  2. Trauma Surgery

     5 topics
    • Initial Assessment and Management
      • Primary Survey (ABCDE)
      • Secondary Survey
      • Trauma Resuscitation
    • Head and Neck Trauma
      • Scalp Lacerations
      • Facial Fractures
      • Neck Injuries
    • Thoracic Trauma
      • Chest Wall Injuries
      • Pulmonary Contusion
      • Cardiac Injuries
    • Abdominal Trauma
      • Solid Organ Injuries
      • Hollow Viscus Injuries
      • Retroperitoneal Hematoma
    • Orthopedic Trauma
      • Fracture Management
      • Dislocations
      • Compartment Syndrome

  3. Gastrointestinal Surgery

     5 topics
    • Esophageal Surgery
      • Achalasia
      • Esophageal Cancer
      • Gastroesophageal Reflux Disease (GERD)
    • Gastric Surgery
      • Peptic Ulcer Disease
      • Gastric Cancer
      • Bariatric Surgery
    • Hepatobiliary Surgery
      • Liver Cirrhosis
      • Hepatocellular Carcinoma
      • Cholecystitis and Cholelithiasis
    • Pancreatic Surgery
      • Pancreatitis
      • Pancreatic Cancer
      • Cystic Neoplasms
    • Colorectal Surgery
      • Colorectal Cancer
      • Inflammatory Bowel Disease
      • Diverticular Disease

  4. Cardiothoracic Surgery

     3 topics
    • Cardiac Surgery
      • Coronary Artery Bypass Grafting (CABG)
      • Valve Replacement Surgery
      • Congenital Heart Defects
    • Thoracic Surgery
      • Lung Cancer Surgery
      • Thoracoscopic Surgery
      • Pleural Diseases
    • Vascular Surgery
      • Aortic Aneurysm
      • Peripheral Arterial Disease
      • Carotid Endarterectomy

  5. Neurosurgery

     3 topics
    • Cranial Surgery
      • Brain Tumors
      • Traumatic Brain Injury
      • Hydrocephalus
    • Spinal Surgery
      • Spinal Cord Injury
      • Degenerative Spine Disease
      • Spinal Tumors
    • Peripheral Nerve Surgery
      • Nerve Repair
      • Carpal Tunnel Syndrome
      • Peripheral Nerve Tumors

  6. Pediatric Surgery

     3 topics
    • Neonatal Surgery
      • Congenital Diaphragmatic Hernia
      • Esophageal Atresia
      • Imperforate Anus
    • Pediatric Oncology
      • Wilms' Tumor
      • Neuroblastoma
      • Rhabdomyosarcoma
    • Pediatric Trauma
      • Pediatric Fractures
      • Abdominal Trauma
      • Head Injuries

  7. Plastic Surgery

     3 topics
    • Reconstructive Surgery
      • Burn Management
      • Cleft Lip and Palate
      • Breast Reconstruction
    • Cosmetic Surgery
      • Rhinoplasty
      • Liposuction
      • Facelift
    • Hand Surgery
      • Carpal Tunnel Release
      • Dupuytren's Contracture
      • Tendon Repair

  8. Urology

     3 topics
    • Renal Surgery
      • Kidney Stones
      • Renal Cell Carcinoma
      • Nephrectomy
    • Bladder Surgery
      • Bladder Cancer
      • Cystectomy
      • Urinary Diversion
    • Prostate Surgery
      • Benign Prostatic Hyperplasia
      • Prostate Cancer
      • Prostatectomy

  9. Orthopedic Surgery

     3 topics
    • Joint Replacement
      • Hip Replacement
      • Knee Replacement
      • Shoulder Replacement
    • Spine Surgery
      • Spinal Fusion
      • Disc Herniation
      • Scoliosis Surgery
    • Sports Injuries
      • ACL Reconstruction
      • Meniscal Repair
      • Rotator Cuff Repair

Clinical Surgery flashcards — 50 questions with answers

  1. What are the six essential components of a preoperative assessment?

    History and physical exam, laboratory/diagnostic testing, cardiac and pulmonary risk assessment, medication review, informed consent, and optimization of comorbidities (e.g., glycemic and blood pressure control).

  2. According to fasting (NPO) guidelines, what are the minimum fasting times before elective surgery for clear liquids, a light meal, and fried/fatty foods?

    Clear liquids: 2 hours; light meal (toast/clear liquids): 6 hours; fried or fatty foods and meat: 8 hours or more.

  3. In the ASA Physical Status Classification, what do classes I through V represent?

    I: normal healthy patient; II: mild systemic disease; III: severe systemic disease; IV: severe systemic disease that is a constant threat to life; V: moribund patient not expected to survive without the operation. (VI = brain-dead organ donor.)

  4. What is the Revised Cardiac Risk Index (RCRI/Lee index) and what are its six predictors?

    A tool predicting major cardiac complications in noncardiac surgery. Predictors: high-risk surgery, ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin-dependent diabetes, and creatinine $> 2\,\text{mg/dL}$ ($>176\,\mu\text{mol/L}$).

  5. When should chronic anticoagulants and antiplatelets typically be managed before surgery: warfarin, clopidogrel, and aspirin?

    Warfarin: stop about 5 days before (bridge high-risk patients with heparin); clopidogrel: stop about 5-7 days before; aspirin: often continued for cardiac patients but stopped 7 days before for high-bleeding-risk surgery.

  6. What is the classic timing and presentation of the five postoperative fever causes ('5 Ws')?

    Wind (atelectasis/pneumonia, days 1-2), Water (UTI, days 3-5), Wound (infection, days 5-7), Walking (DVT/PE, days 5+), Wonder drugs/What did we do (drug fever, IV lines, anytime).

  7. What is the most common cause of fever in the first 24-48 hours after surgery?

    Atelectasis (though evidence links early fever more to inflammatory cytokine response); managed with incentive spirometry, early mobilization, and deep breathing.

  8. What are the key elements of postoperative VTE prophylaxis?

    Early ambulation, mechanical prophylaxis (intermittent pneumatic compression, graduated stockings), and pharmacologic prophylaxis with low-molecular-weight heparin or unfractionated heparin, risk-stratified by the Caprini score.

  9. What is postoperative ileus, and when does normal bowel function typically return by segment?

    Transient impairment of GI motility after surgery. Normal recovery: small bowel within 24 hours, stomach 24-48 hours, and colon 48-72 hours. Prolonged ileus beyond 3-5 days warrants workup.

  10. Distinguish wound dehiscence from evisceration.

    Dehiscence is partial or complete separation of the fascial layers of a surgical wound; evisceration is protrusion of abdominal viscera through the dehisced wound—a surgical emergency requiring sterile moist covering and return to OR.

  11. What is SIRS and what four criteria define it (two or more required)?

    Systemic Inflammatory Response Syndrome. Criteria: temperature $>38^{\circ}\text{C}$ or $<36^{\circ}\text{C}$; heart rate $>90$/min; respiratory rate $>20$/min or $\text{PaCO}_2 <32\,\text{mmHg}$; WBC $>12{,}000$ or $<4000/\mu\text{L}$ or $>10\%$ bands.

  12. How is a surgical site infection (SSI) classified by depth?

    Superficial incisional (skin/subcutaneous), deep incisional (fascia/muscle), and organ/space SSI (any part deeper than fascia manipulated during surgery). Occurs within 30 days (or 90 days with implants).

  13. What is the wound classification system and expected infection rates for clean, clean-contaminated, contaminated, and dirty wounds?

    Clean ($<2\%$), clean-contaminated (controlled entry into hollow viscus, $\sim3$-$11\%$), contaminated (gross spillage/fresh trauma, $\sim10$-$17\%$), dirty (established infection/perforated viscus, $>27\%$).

  14. When should prophylactic antibiotics be administered relative to surgical incision, and when should they be redosed?

    Within 60 minutes before incision (120 minutes for vancomycin/fluoroquinolones); redose intraoperatively after 2 half-lives or with significant blood loss ($>1500\,\text{mL}$). Discontinue within 24 hours postop.

  15. What organism causes necrotizing fasciitis type I versus type II, and what is the treatment?

    Type I: polymicrobial (aerobes + anaerobes); Type II: monomicrobial, usually Group A Streptococcus ($\pm$ S. aureus). Treatment: emergent surgical debridement plus broad-spectrum antibiotics and supportive care.

  16. What are the classic clinical signs suggesting necrotizing soft tissue infection?

    Pain out of proportion to exam, skin crepitus, hemorrhagic bullae, rapidly spreading erythema, systemic toxicity, and 'dishwater' gray drainage. LRINEC score aids diagnosis.

  17. What are the four phases of wound healing?

    Hemostasis (immediate, clot formation), inflammation (days 1-4, neutrophils then macrophages), proliferation (days 4-21, fibroblasts, collagen, angiogenesis, epithelialization), and remodeling/maturation (weeks to years, collagen type III replaced by type I).

  18. Compare healing by primary, secondary, and tertiary intention.

    Primary: wound edges approximated directly (sutured). Secondary: wound left open to heal by granulation and contraction. Tertiary (delayed primary): wound left open initially then closed later once infection risk falls.

  19. What are the components of the primary survey in trauma (ATLS)?

    ABCDE: Airway with cervical spine protection, Breathing/ventilation, Circulation with hemorrhage control, Disability (neurologic/GCS), Exposure/environment control (undress and prevent hypothermia).

  20. State the Glasgow Coma Scale components and score range.

    Eye opening (1-4), verbal response (1-5), and motor response (1-6), for a total range of 3-15. GCS $\leq 8$ generally indicates need for definitive airway.

Show the other 30 Surgery flashcards

  1. What are the four classes of hemorrhagic shock by blood loss and their key vital sign changes?

    Class I: $<15\%$ ($<750\,\text{mL}$), normal vitals; Class II: 15-30\% (750-1500 mL), tachycardia, narrowed pulse pressure; Class III: 30-40\% (1500-2000 mL), hypotension, tachycardia, altered mental status; Class IV: $>40\%$ ($>2000\,\text{mL}$), life-threatening, lethargy.

  2. What is the 'lethal triad' (trauma triad of death)?

    Hypothermia, acidosis, and coagulopathy—a self-reinforcing cycle in severely injured patients that guides damage-control resuscitation and permissive hypotension strategies.

  3. What structures are assessed on the FAST exam and what does it detect?

    Focused Assessment with Sonography in Trauma views: perihepatic (Morrison's pouch), perisplenic, pelvis (pouch of Douglas), and pericardium—detecting free intraperitoneal fluid/blood and pericardial effusion/tamponade.

  4. What are the three components of Beck's triad in cardiac tamponade?

    Hypotension, muffled heart sounds, and distended neck veins (elevated jugular venous pressure). Pulsus paradoxus is also often present.

  5. How do you differentiate tension pneumothorax from cardiac tamponade on exam?

    Both cause hypotension and distended neck veins. Tension pneumothorax has absent breath sounds and hyperresonance on the affected side with tracheal deviation away; tamponade has muffled heart sounds and normal/bilateral breath sounds.

  6. What are the six immediately life-threatening thoracic injuries identified in the primary survey?

    Airway obstruction, tension pneumothorax, open pneumothorax (sucking chest wound), massive hemothorax, flail chest, and cardiac tamponade.

  7. Define massive hemothorax and its indications for thoracotomy.

    Massive hemothorax is $>1500\,\text{mL}$ blood on initial chest tube drainage. Thoracotomy indicated for initial drainage $>1500\,\text{mL}$, or ongoing $>200\,\text{mL/hr}$ for 2-4 hours, or persistent need for transfusion.

  8. What defines flail chest and its underlying physiologic problem?

    Two or more consecutive ribs fractured in two or more places, creating a free segment with paradoxical movement. The main morbidity is the underlying pulmonary contusion causing hypoxia; treated with analgesia and pulmonary support.

  9. What is the Cushing reflex and what does it indicate?

    The triad of hypertension (widened pulse pressure), bradycardia, and irregular respirations—a sign of raised intracranial pressure and impending brain herniation.

  10. Compare epidural and subdural hematoma in terms of vessel, CT appearance, and clinical course.

    Epidural: middle meningeal artery, biconvex (lens-shaped) not crossing sutures, classic lucid interval. Subdural: bridging veins, crescent-shaped crossing sutures, more common in elderly/alcoholics with slower onset.

  11. What is the initial management of a positive FAST with hemodynamic instability in abdominal trauma?

    Emergent exploratory laparotomy. Hemodynamically stable patients with positive imaging may undergo CT and possible nonoperative management or angioembolization.

  12. Which solid organ is most commonly injured in blunt abdominal trauma, and what grades favor nonoperative management?

    The spleen. Low-grade injuries (AAST grades I-III) in hemodynamically stable patients are often managed nonoperatively $\pm$ angioembolization; high grades or instability favor splenectomy.

  13. What vaccinations are required after splenectomy and why?

    Vaccines against encapsulated organisms: Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b—to prevent overwhelming post-splenectomy infection (OPSI). Give ideally 2 weeks before elective splenectomy or 2 weeks postop.

  14. What is the Ottawa Ankle Rule and its purpose?

    A clinical decision rule to determine need for ankle/foot X-rays: image if pain in the malleolar zone plus bony tenderness at the posterior edge/tip of either malleolus, or inability to bear weight for 4 steps. Reduces unnecessary radiographs.

  15. What is compartment syndrome and the '6 Ps' of its presentation?

    Elevated pressure within a fascial compartment compromising perfusion. The 6 Ps: Pain (out of proportion, worse on passive stretch), Paresthesia, Pallor, Poikilothermia, Pulselessness (late), and Paralysis (late). Treated with emergent fasciotomy.

  16. At what compartment pressure or delta pressure is fasciotomy indicated?

    Absolute compartment pressure $>30\,\text{mmHg}$, or a delta pressure (diastolic BP minus compartment pressure) $<30\,\text{mmHg}$. Clinical suspicion outweighs numbers.

  17. What is the difference between an open (compound) and closed fracture, and how does management differ?

    Open fracture communicates with the external environment through broken skin; closed fracture does not. Open fractures require urgent antibiotics, tetanus prophylaxis, and surgical irrigation/debridement due to infection risk (Gustilo-Anderson classification).

  18. What is the classic triad and diagnostic triad for achalasia, and what is the surgical treatment?

    Presentation: dysphagia to solids and liquids, regurgitation, weight loss. Manometry shows failure of LES relaxation and absent peristalsis; barium swallow shows 'bird's beak.' Surgical treatment: laparoscopic Heller myotomy with partial fundoplication (or POEM).

  19. What is Boerhaave syndrome and its typical presentation?

    Spontaneous transmural esophageal rupture from forceful vomiting, usually the left posterolateral distal esophagus. Presents with Mackler triad: vomiting, chest pain, and subcutaneous emphysema. Requires urgent surgical repair.

  20. What operation is standard for a Zenker diverticulum, and where does it arise?

    A pharyngoesophageal (pulsion, false) diverticulum arising through Killian's triangle above the cricopharyngeus. Treatment: cricopharyngeal myotomy with diverticulectomy or diverticulopexy (or endoscopic stapling).

  21. What is the modified Johnson classification of gastric ulcers by location and acid status?

    Type I: lesser curve/incisura (normal-low acid); Type II: gastric body + duodenal (high acid); Type III: prepyloric (high acid); Type IV: high lesser curve near GE junction (normal-low acid); Type V: NSAID-related, anywhere.

  22. What are the risk factors for gastric adenocarcinoma and the surgical margins required?

    Risk factors: H. pylori, chronic atrophic gastritis, pernicious anemia, smoked/salted foods, smoking, prior gastric surgery. Surgery requires gastrectomy with $\geq 5\,\text{cm}$ margins and D2 lymphadenectomy.

  23. State Charcot's triad and Reynolds' pentad for cholangitis.

    Charcot's triad: fever, right upper quadrant pain, and jaundice. Reynolds' pentad adds hypotension and altered mental status, indicating suppurative cholangitis requiring urgent biliary decompression.

  24. What are the components of Calot's triangle and its surgical significance?

    Bounded by the cystic duct, common hepatic duct, and inferior liver edge; contains the cystic artery and Lund's node. Identifying the 'critical view of safety' here prevents common bile duct injury during cholecystectomy.

  25. How is acute pancreatitis diagnosed, and what two scoring systems assess severity?

    Diagnosis requires 2 of 3: characteristic epigastric pain radiating to back, lipase/amylase $>3\times$ upper limit of normal, or characteristic imaging. Severity assessed by Ranson's criteria and APACHE II (also BISAP).

  26. What is the Whipple procedure (pancreaticoduodenectomy) and what structures are removed?

    Resection for periampullary/pancreatic head tumors: removal of the pancreatic head, duodenum, gallbladder, common bile duct, and often the gastric antrum, followed by pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy.

  27. What is the difference between an anterior resection and abdominoperineal resection (APR) for rectal cancer?

    Anterior/low anterior resection removes the tumor with restoration of bowel continuity, preserving the anal sphincter. APR removes the rectum and anus with a permanent end colostomy, used for very low tumors involving the sphincter.

  28. What is the recommended surgical margin and lymph node yield for colon cancer resection?

    Proximal and distal bowel margins of $\geq 5\,\text{cm}$ with high ligation of the feeding vessel; a minimum of 12 lymph nodes should be examined for adequate staging.

  29. What is the CHA2DS2-VASc score used for, and which cardiac surgery addresses refractory AF?

    It estimates stroke risk in atrial fibrillation to guide anticoagulation (Congestive heart failure, Hypertension, Age $\geq75$ [2 pts], Diabetes, Stroke/TIA [2 pts], Vascular disease, Age 65-74, Sex female). The surgical Cox-Maze procedure treats refractory AF.

  30. For an abdominal aortic aneurysm, at what diameter is elective repair indicated and what is the classic ruptured-AAA triad?

    Elective repair when diameter $\geq 5.5\,\text{cm}$, rapid expansion ($>0.5\,\text{cm}$ in 6 months), or symptomatic. Ruptured AAA triad: hypotension, pulsatile abdominal mass, and abrupt back/flank pain.

Same Surgery syllabus in other exams

The Surgery outline above is identical in these 2 exams:

Clinical Surgery FAQ

What is in the Clinical Surgery syllabus?

Clinical Surgery is split into 9 chapters: General Surgery, Trauma Surgery, Gastrointestinal Surgery, Cardiothoracic Surgery, Neurosurgery, Pediatric Surgery, Plastic Surgery, Urology and Orthopedic Surgery. Together they contain 32 topics and 98 sub-topics.

How many chapters are in Clinical Surgery?

9 chapters, containing 32 topics and 98 sub-topics. The largest chapter is Trauma Surgery, with 5 topics.

Are there flashcards for Clinical Surgery?

Yes — a 50-card Surgery deck, printed in full in the flashcards section of this page and available in the Examius app with spaced repetition. The free plan covers one exam of your choice, including its flashcards; Examius Pro, a one-time purchase, unlocks every other exam and deck.