Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Surgery, Emergency Medicine, and Musculoskeletal Care Syllabus

Surgery, Emergency Medicine, and Musculoskeletal Care syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Surgery, Emergency Medicine, and Musculoskeletal Care in Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), not a summary of it.

1. 1

   General and Abdominal Surgery

   4 topics

   • Acute Abdomen
     • Appendicitis, cholecystitis, diverticulitis
     • Bowel obstruction and perforation
   • Hernias and Abdominal Wall
     • Inguinal, femoral, and incisional hernias
   • Perioperative Care
     • Preoperative risk assessment
     • Postoperative complications
   • Surgical Oncology Principles
     • Breast and colorectal evaluation
2. 2

   Trauma and Emergency Medicine

   4 topics

   • Initial Trauma Assessment
     • Primary and secondary survey
     • Shock recognition and resuscitation
   • Cardiopulmonary Emergencies
     • Cardiac arrest and ACLS
     • Acute respiratory failure
   • Toxicology and Environmental Emergencies
     • Common poisonings and antidotes
     • Burns, hypothermia, and heat illness
   • Wound and Acute Care Management
     • Laceration repair and wound assessment
3. 3

   Orthopedics and Musculoskeletal Medicine

   4 topics

   • Fractures and Dislocations
     • Fracture classification and management
     • Compartment syndrome and emergencies
   • Sports and Soft Tissue Injuries
     • Sprains, strains, and tendinopathies
     • Common joint injuries
   • Degenerative and Inflammatory Joint Disease
     • Osteoarthritis evaluation
   • Spine and Back Pain
     • Mechanical and radicular back pain
     • Red-flag screening
4. 4

   Surgical Subspecialties

   4 topics

   • Urology
     • Nephrolithiasis and urinary retention
     • Prostate and testicular disorders
   • Otolaryngology and Ophthalmology
     • Common ENT presentations
     • Acute vision loss and red eye
   • Vascular and Thoracic Surgery
     • Aneurysm and acute limb ischemia
   • Anesthesia Principles
     • Airway management and analgesia

Surgery, Emergency Medicine, and Musculoskeletal Care flashcards for Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA)

25 of 61 cards from the Surgery, Emergency Medicine, and Musculoskeletal Care deck — real questions with worked answers.

1. What is the classic clinical triad suggesting a perforated viscus as a cause of acute abdomen?

   Sudden severe abdominal pain, board-like rigidity (involuntary guarding/peritonitis), and free air under the diaphragm on upright chest X-ray.

2. In acute appendicitis, where does pain classically migrate, and what is McBurney's point?

   Pain begins periumbilically (visceral) then migrates to the right lower quadrant (somatic). McBurney's point is 1/3 of the distance from the anterior superior iliac spine to the umbilicus.

3. Name the eponymous signs of appendicitis: Rovsing, Psoas, and Obturator.

   Rovsing = RLQ pain on LLQ palpation; Psoas = RLQ pain on right hip extension (retrocecal appendix); Obturator = RLQ pain on internal rotation of flexed right hip (pelvic appendix).

4. What imaging finding on abdominal X-ray suggests sigmoid volvulus?

   A 'coffee bean' or 'inverted U/bent inner tube' sign, with the apex of the distended loop pointing toward the right upper quadrant.

5. Distinguish small bowel obstruction from large bowel obstruction on plain film.

   SBO: dilated central loops with valvulae conniventes crossing the full lumen, multiple air-fluid levels, little colonic gas. LBO: peripheral dilation with haustra that do not cross the lumen.

6. What is the most common cause of small bowel obstruction in adults, and the most common cause of large bowel obstruction?

   SBO: postoperative adhesions (then hernias). LBO: colorectal cancer (then diverticular stricture and volvulus).

7. Define the difference between a reducible, incarcerated, and strangulated hernia.

   Reducible: contents return to abdomen. Incarcerated: contents trapped, cannot be reduced (risk of obstruction). Strangulated: incarcerated with compromised blood supply (ischemia/necrosis) — a surgical emergency.

8. Differentiate indirect from direct inguinal hernias by anatomy.

   Indirect: passes through the deep (internal) ring lateral to the inferior epigastric vessels, follows the spermatic cord, may reach the scrotum (often congenital/patent processus vaginalis). Direct: protrudes through Hesselbach's triangle medial to the inferior epigastric vessels (acquired wall weakness).

9. What are the borders of Hesselbach's triangle?

   Inferior epigastric vessels (lateral), lateral border of the rectus abdominis (medial), and the inguinal ligament (inferior).

10. Which hernia passes below the inguinal ligament through the femoral canal, and why is it concerning?

    Femoral hernia — passes medial to the femoral vein through the femoral canal. More common in women and has a high risk of incarceration/strangulation due to the narrow, rigid neck.

11. What does the Caprini score assess, and what is standard perioperative VTE prophylaxis for a moderate-to-high-risk surgical patient?

    The Caprini score stratifies venous thromboembolism risk. Moderate-to-high risk patients receive pharmacologic prophylaxis (low-molecular-weight heparin or low-dose unfractionated heparin) plus mechanical prophylaxis (sequential compression devices).

12. According to the Revised Cardiac Risk Index (RCRI), name the six predictors of perioperative cardiac complications.

    High-risk surgery, ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin-dependent diabetes, and preoperative creatinine >2.0 mg/dL.

13. How should perioperative beta-blockers be managed in a patient already taking them chronically?

    Continue chronic beta-blockers through the perioperative period; abrupt withdrawal risks rebound tachycardia, ischemia, and arrhythmia. Do not newly start high-dose beta-blockade on the day of surgery.

14. What is the most common cause of fever in the first 24-48 hours after surgery, and what are the classic '5 Ws' timeline?

    Early postoperative fever is often atelectasis. The 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, line infection, anytime).

15. State the principle of surgical margins and the role of sentinel lymph node biopsy in surgical oncology.

    The goal is complete resection with tumor-free (negative) margins (R0). Sentinel lymph node biopsy identifies the first draining node(s) to assess regional spread while minimizing the morbidity of full lymphadenectomy.

16. What does the TNM staging system stand for in cancer?

    T = size/extent of the primary tumor, N = regional lymph node involvement, M = distant metastasis.

17. Define neoadjuvant versus adjuvant therapy in cancer treatment.

    Neoadjuvant therapy is given before the primary (surgical) treatment to shrink the tumor. Adjuvant therapy is given after primary treatment to eliminate residual micrometastatic disease.

18. List the components of the primary survey (ABCDE) in initial trauma assessment.

    A = Airway with cervical spine protection, B = Breathing/ventilation, C = Circulation with hemorrhage control, D = Disability (neuro/GCS), E = Exposure/Environment (undress, prevent hypothermia).

19. What are the three components and total range of the Glasgow Coma Scale?

    Eye opening (1-4), Verbal response (1-5), and Motor response (1-6); total range 3 to 15. A GCS ≤8 generally indicates the need for definitive airway control (intubation).

20. Name the four classes of hemorrhagic shock by approximate blood loss and key vital sign change.

    Class I: <15% (normal vitals); Class II: 15-30% (tachycardia, narrowed pulse pressure); Class III: 30-40% (hypotension, tachycardia, confusion); Class IV: >40% (markedly low BP, lethargy, minimal urine output).

21. What is the lethal triad of trauma that worsens hemorrhage?

    Hypothermia, acidosis, and coagulopathy — a self-perpetuating cycle that increases mortality and is addressed by damage control resuscitation.

22. What two life threats does eFAST/chest exam look for that present as obstructive shock in trauma, and how are they distinguished?

    Tension pneumothorax (hyperresonance, absent breath sounds, tracheal deviation away — treat with needle decompression/chest tube) and cardiac tamponade (Beck's triad: hypotension, distended neck veins, muffled heart sounds — treat with pericardiocentesis).

23. What ECG rhythms are shockable versus non-shockable in cardiac arrest?

    Shockable: ventricular fibrillation and pulseless ventricular tachycardia (defibrillate). Non-shockable: pulseless electrical activity (PEA) and asystole (CPR + epinephrine, treat reversible causes).

24. List the reversible causes of cardiac arrest — the Hs and Ts.

    Hs: Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia. Ts: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), Thrombosis (coronary).

25. What is the dose and route of epinephrine in adult cardiac arrest?

    1 mg of 1:10,000 IV/IO every 3-5 minutes during CPR.

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