FMGE Surgery Syllabus

Surgery syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Surgery in FMGE, not a summary of it.

1. 1

   General Surgery

   3 topics

   • Principles of surgery
     • Aseptic technique
     • Surgical instruments
     • Wound healing
     • Surgical complications
   • Preoperative evaluation
     • Patient assessment
     • Informed consent
     • Preoperative optimization
     • Risk stratification
   • Postoperative care
     • Monitoring
     • Pain management
     • Wound care
     • Prevention of surgical site infections
2. 2

   Gastrointestinal Surgery

   4 topics

   • Abdominal wall hernias
     • Inguinal hernia
     • Femoral hernia
     • Umbilical hernia
     • Incisional hernia
   • Esophageal disorders
     • Gastroesophageal reflux disease (GERD)
     • Esophageal cancer
     • Achalasia
     • Esophageal diverticula
   • Gastric and duodenal disorders
     • Peptic ulcer disease
     • Gastric cancer
     • Duodenal diverticula
   • Colorectal disorders
     • Colorectal cancer
     • Diverticular disease
     • Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
     • Anorectal disorders (hemorrhoids, anal fissures)
3. 3

   Hepatobiliary Surgery

   3 topics

   • Gallbladder diseases
     • Cholelithiasis
     • Cholecystitis
     • Gallbladder polyps
     • Gallbladder cancer
   • Liver diseases
     • Hepatocellular carcinoma
     • Liver abscess
     • Hepatic cysts
     • Liver transplantation
   • Pancreatic diseases
     • Pancreatitis
     • Pancreatic cancer
     • Pancreatic pseudocysts
     • Pancreatic neuroendocrine tumors
4. 4

   Endocrine Surgery

   3 topics

   • Thyroid disorders
     • Thyroid nodules
     • Thyroid cancer
     • Graves' disease
     • Thyroidectomy
   • Parathyroid disorders
     • Primary hyperparathyroidism
     • Parathyroid adenoma
     • Parathyroidectomy
   • Adrenal disorders
     • Adrenal incidentaloma
     • Adrenal adenoma
     • Adrenal carcinoma
     • Adrenalectomy
5. 5

   Breast Surgery

   2 topics

   • Benign breast disorders
     • Fibroadenoma
     • Fibrocystic changes
     • Breast cysts
     • Breast pain
   • Breast cancer
     • Diagnosis
     • Staging
     • Lumpectomy
     • Mastectomy
     • Breast reconstruction
6. 6

   Vascular Surgery

   3 topics

   • Arterial diseases
     • Atherosclerosis
     • Peripheral arterial disease (PAD)
     • Abdominal aortic aneurysm (AAA)
     • Carotid artery disease
   • Venous diseases
     • Varicose veins
     • Deep vein thrombosis (DVT)
     • Venous insufficiency
     • Venous ulcers
   • Vascular access
     • Central venous catheterization
     • Arteriovenous fistula (AVF)
     • Arteriovenous graft (AVG) creation for hemodialysis
7. 7

   Trauma Surgery

   3 topics

   • Evaluation and management of trauma patients
     • Primary survey (ABCDE approach)
     • Secondary survey
     • Management of life-threatening injuries
   • Traumatic brain injury
     • Head injury classification (Glasgow Coma Scale, Traumatic Brain Injury Severity Score)
     • Intracranial hemorrhage
     • Surgical interventions (craniotomy, craniectomy)
   • Abdominal trauma
     • Blunt abdominal trauma
     • Penetrating abdominal trauma
     • Solid organ injuries (liver, spleen)
     • Hollow viscus injuries (bowel perforation)
8. 8

   Orthopedic Surgery

   3 topics

   • Fractures and Dislocations
     • Principles of fracture management (reduction, fixation)
     • Closed fractures
     • Open fractures
     • Common fractures
   • Joint Replacement Surgery
     • Total hip replacement (THR)
     • Total knee replacement (TKR)
     • Shoulder arthroplasty
   • Spine Surgery
     • Degenerative spine disorders
     • Spinal fusion
     • Laminectomy
9. 9

   Renal and ureteric disorders

   4 topics

   • Renal stones
   • Renal cell carcinoma
   • Ureteropelvic junction (UPJ) obstruction
   • Ureteral strictures
10. 10

    Pediatric Surgery

    2 topics

    • Neonatal surgery
      • Congenital anomalies (gastroschisis, omphalocele)
      • Congenital diaphragmatic hernia (CDH)
      • Esophageal atresia
    • Pediatric abdominal surgery
      • Appendicitis
      • Intussusception
      • Hirschsprung's disease
      • Pediatric tumors (Wilms tumor, neuroblastoma)

Surgery flashcards for FMGE

18 of 79 cards from the Surgery deck — real questions with worked answers.

1. What are the five components of the surgical "sterile technique" sequence performed before incision (the surgical scrub workflow)?

   Surgical hand antisepsis (scrub), sterile gown and gloves, patient skin antisepsis (e.g., chlorhexidine-alcohol), sterile draping, and a pre-incision time-out/safety checklist.

2. Define the four classes of surgical wounds by contamination and their approximate infection risk.

   Clean (no viscus entered, ~1-2%), Clean-contaminated (controlled viscus entry, no spillage, ~3-5%), Contaminated (gross spillage or fresh trauma, ~10-15%), Dirty/Infected (established infection or perforated viscus, >25%).

3. What is the optimal timing for prophylactic antibiotics in surgery and the most common agent for clean-contaminated cases?

   Within 60 minutes before skin incision (120 min for vancomycin/fluoroquinolones); a first/second-generation cephalosporin such as cefazolin is most commonly used.

4. What ASA Physical Status classification is assigned to a patient with severe systemic disease that is a constant threat to life?

   ASA IV. (I = healthy, II = mild systemic disease, III = severe systemic disease, IV = severe disease that is a constant threat to life, V = moribund, VI = brain-dead organ donor.)

5. In preoperative cardiac risk assessment, name the components of the Revised Cardiac Risk Index (RCRI/Lee index).

   High-risk surgery, ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin-dependent diabetes, and preoperative creatinine >2 mg/dL.

6. How long before elective surgery should warfarin be stopped, and what is the typical INR target for safe surgery?

   Stop warfarin ~5 days before surgery; aim for INR ≤1.5 (often ≤1.4) before proceeding, with bridging anticoagulation in high thromboembolic-risk patients.

7. What are the standard preoperative fasting (NPO) guidelines for clear liquids, breast milk, and solid food/fatty meals?

   Clear liquids: 2 hours; breast milk: 4 hours; infant formula/light meal: 6 hours; fatty or fried meals: 8 hours before anesthesia.

8. List the classic timeline of postoperative fever causes (the "5 Ws").

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

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

   Atelectasis (collapse of alveoli), classically presenting on postoperative day 1-2; managed with incentive spirometry, deep breathing, and early mobilization.

10. Define postoperative ileus versus mechanical bowel obstruction in terms of bowel sounds and imaging.

    Ileus: functional paralysis with absent/hypoactive bowel sounds and diffuse gas in both small and large bowel on X-ray. Mechanical obstruction: hyperactive high-pitched sounds with dilated loops proximal and gas paucity distal to a transition point.

11. What is the most common organism causing surgical site infections, and which produces gas gangrene?

    Staphylococcus aureus is the most common SSI organism; Clostridium perfringens causes gas gangrene (myonecrosis).

12. What anatomical boundary distinguishes a direct from an indirect inguinal hernia?

    Indirect hernias pass through the deep (internal) inguinal ring, lateral to the inferior epigastric vessels; direct hernias protrude through Hesselbach's triangle, medial to the inferior epigastric vessels.

13. Define the boundaries of Hesselbach's triangle.

    Medial: lateral border of rectus abdominis; lateral/superolateral: inferior epigastric vessels; inferior: inguinal ligament.

14. Differentiate an incarcerated from a strangulated hernia.

    Incarcerated: irreducible hernia contents but viable. Strangulated: irreducible hernia with compromised blood supply causing ischemia/necrosis — a surgical emergency presenting with severe pain, tenderness, and systemic signs.

15. Which hernia passes through the femoral canal, who gets it most, and why is it high-risk?

    Femoral hernia passes below the inguinal ligament through the femoral canal; most common in older women; high risk of strangulation due to the narrow, rigid femoral ring.

16. What is the classic triad of achalasia and the diagnostic gold standard?

    Triad: dysphagia (to both solids and liquids), regurgitation, and weight loss. Gold standard diagnosis is esophageal manometry showing incomplete LES relaxation and absent peristalsis ("bird-beak" on barium swallow).

17. What is Boerhaave syndrome and how does it classically present?

    Spontaneous full-thickness esophageal rupture, usually after forceful vomiting; presents with Mackler's triad of vomiting, severe chest pain, and subcutaneous emphysema. Gastrografin esophagram confirms; needs emergency surgical repair.

18. Which type of hiatal hernia is the dangerous one requiring surgery, and why?

    Type II-IV (paraesophageal) hernias, where the gastric fundus herniates beside the esophagus while the GE junction stays in place; risk of incarceration, volvulus, and strangulation. (Type I sliding hernias are most common but usually managed medically.)

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