NExT Surgery and Allied Specialties (General Surgery, Orthopedics, Anesthesiology, Radiodiagnosis) Syllabus

Surgery and Allied Specialties (General Surgery, Orthopedics, Anesthesiology, Radiodiagnosis) syllabus: all 6 chapters

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

1. 1

   Principles of Surgery and Perioperative Care

   5 topics

   • Wound Healing and Surgical Site Infection
   • Fluid, Electrolyte and Acid-Base Management
   • Shock and Hemorrhage
     • Hypovolemic, septic, cardiogenic shock
   • Nutrition in Surgical Patients
   • Surgical Audit, Consent and Day-Care Surgery
2. 2

   Gastrointestinal and Hepatobiliary Surgery

   6 topics

   • Acute Abdomen and Peritonitis
     • Appendicitis, perforation, intestinal obstruction
   • Hernias
     • Inguinal, femoral, incisional; complications
   • Hepatobiliary Disorders
     • Gallstones, cholecystitis, obstructive jaundice
   • Pancreatic Disorders
     • Acute and chronic pancreatitis, carcinoma
   • Gastrointestinal Malignancies
     • Esophageal, gastric, colorectal carcinoma
   • Anorectal Disorders
     • Hemorrhoids, fistula-in-ano, fissure
3. 3

   Trauma, Breast, Endocrine and Vascular Surgery

   5 topics

   • Polytrauma Management
     • ATLS primary and secondary survey
     • Head, chest and abdominal trauma
   • Breast Diseases
     • Benign breast disease and carcinoma breast
   • Thyroid and Parathyroid Surgery
     • Solitary nodule, goiter, thyroid malignancy
   • Vascular Surgery
     • Peripheral arterial disease, varicose veins, aneurysms
   • Burns and Reconstruction
     • Burn assessment, fluid resuscitation, grafts and flaps
4. 4

   Orthopedics and Musculoskeletal Disorders

   5 topics

   • Fractures and Dislocations
     • Principles of fracture healing and fixation
     • Common fractures: Colles, hip, spine
   • Bone and Joint Infections
     • Osteomyelitis, septic arthritis, skeletal TB
   • Bone Tumors
     • Benign and malignant; osteosarcoma, GCT
   • Degenerative and Metabolic Bone Disease
     • Osteoarthritis, osteoporosis, rickets
   • Congenital and Pediatric Orthopedics
     • CTEV, DDH, cerebral palsy
5. 5

   Anesthesiology and Critical Care

   5 topics

   • Preoperative Assessment and ASA Grading
   • General and Regional Anesthesia
     • Spinal, epidural, nerve blocks
   • Airway Management and Resuscitation
     • BLS, ACLS, difficult airway
   • Pain Management and Analgesia
   • Mechanical Ventilation and ICU Monitoring
6. 6

   Radiodiagnosis and Imaging

   5 topics

   • Principles of Radiography and Contrast Studies
   • Cross-Sectional Imaging
     • CT, MRI, ultrasonography principles
   • Chest and Cardiac Imaging
   • Abdominal and Pelvic Imaging
   • Interventional Radiology and Radiation Safety

NExT Surgery and Allied Specialties (General Surgery, Orthopedics, Anesthesiology, Radiodiagnosis) flashcards — 51 questions with answers

1. What are the four classic phases of wound healing and their approximate timeframes?

   1) Hemostasis (immediate), 2) Inflammation (day 1-5), 3) Proliferation/fibroplasia (day 5 to ~3 weeks, collagen type III), 4) Remodeling/maturation (3 weeks to 1 year, collagen III replaced by type I).

2. How are surgical wounds classified for infection risk, and what are typical SSI rates for each?

   Clean (~1-2%), Clean-contaminated (~3-5%, controlled entry of viscus), Contaminated (~10%, gross spillage/acute inflammation), Dirty/infected (>25%, established infection/perforation).

3. By what time after surgery does a surgical site infection conventionally occur (without implant vs with implant)?

   Within 30 days of surgery, or within 90 days (up to 1 year by older CDC criteria) if a prosthetic implant is left in place.

4. State the Maintenance fluid requirement using the 4-2-1 rule.

   4 mL/kg/hr for first 10 kg + 2 mL/kg/hr for next 10 kg + 1 mL/kg/hr for each kg above 20 kg.

5. What is the composition of Ringer's lactate (Hartmann's solution)?

   Na+ 130, K+ 4-5, Ca2+ 2-3, Cl- 109-111, lactate 28 mmol/L; isotonic, used for resuscitation.

6. Give the anion gap formula and the normal range.

   Anion gap = Na+ - (Cl- + HCO3-); normal 8-12 mmol/L (correct for albumin: add 2.5 per 1 g/dL fall in albumin).

7. List the four classes of hemorrhagic shock by the ATLS classification with blood loss percentages.

   Class I: <15% (<750 mL); Class II: 15-30% (750-1500 mL); Class III: 30-40% (1500-2000 mL); Class IV: >40% (>2000 mL).

8. What is the earliest reliable vital-sign change in hemorrhagic (hypovolemic) shock?

   Tachycardia with narrowed pulse pressure (rising diastolic from increased SVR); hypotension is a late sign appearing after ~30% loss.

9. Differentiate the hemodynamic profile of septic vs cardiogenic vs hypovolemic shock (CO, SVR, CVP).

   Septic (warm/distributive): high/normal CO, low SVR, low CVP. Cardiogenic: low CO, high SVR, high CVP. Hypovolemic: low CO, high SVR, low CVP.

10. What is the formula for daily caloric requirement and protein requirement in a stable surgical patient?

    ~25-30 kcal/kg/day total energy; protein 1.0-1.5 g/kg/day (up to 2 g/kg in catabolic/burn states).

11. What is refeeding syndrome and its hallmark electrolyte abnormality?

    Metabolic disturbance on reintroducing nutrition to malnourished patients; hallmark is hypophosphatemia (also hypokalemia, hypomagnesemia, thiamine deficiency, fluid overload).

12. What is the ASA physical status classification (I-VI) in brief?

    I: normal healthy; II: mild systemic disease; III: severe systemic disease; IV: severe disease that is a constant threat to life; V: moribund, not expected to survive without operation; VI: brain-dead organ donor. 'E' suffix = emergency.

13. What are the three valid elements of informed surgical consent?

    Disclosure of relevant information (nature, risks, benefits, alternatives), patient capacity/competence, and voluntariness (no coercion).

14. What is the most common cause of acute abdomen requiring surgery, and McBurney's point location?

    Acute appendicitis; McBurney's point lies 1/3 of the distance from the anterior superior iliac spine to the umbilicus.

15. Distinguish primary, secondary and tertiary peritonitis.

    Primary: spontaneous bacterial peritonitis without GI perforation (e.g., SBP in cirrhosis). Secondary: from GI perforation/contamination (most common). Tertiary: persistent/recurrent infection after adequate treatment of secondary peritonitis.

16. What free air sign on erect chest X-ray indicates hollow viscus perforation?

    Free gas under the diaphragm (pneumoperitoneum).

17. Differentiate direct and indirect inguinal hernia by their relation to the inferior epigastric vessels.

    Indirect hernia passes lateral to the inferior epigastric vessels through the deep ring; direct hernia bulges medial to them through Hesselbach's triangle.

18. What are the boundaries of Hesselbach's triangle?

    Medially: lateral border of rectus abdominis; laterally: inferior epigastric vessels; inferiorly: inguinal ligament.

19. Define a strangulated hernia and what distinguishes it from an obstructed hernia.

    Strangulated = compromised blood supply causing ischemia/gangrene of contents (tender, irreducible, systemically unwell). Obstructed = lumen blocked causing intestinal obstruction but blood supply initially intact.

20. What is Charcot's triad and Reynolds' pentad in cholangitis?

    Charcot's triad: RUQ pain, fever, jaundice. Reynolds' pentad: Charcot's triad + hypotension/shock + altered mental status (suppurative cholangitis).

NExT Surgery and Allied Specialties (General Surgery, Orthopedics, Anesthesiology, Radiodiagnosis) FAQ