PMDC National Licensing Examination Surgery and Allied Syllabus

Surgery and Allied syllabus — full chapter and topic list

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

1. 1

   General Surgery Principles

   4 topics

   • Wound Healing and Surgical Infections
   • Fluid, Electrolyte and Nutritional Support
   • Shock and Hemorrhage
   • Pre-operative and Post-operative Care
2. 2

   Gastrointestinal Surgery

   4 topics

   • Acute Abdomen and Appendicitis
   • Hernias
   • Biliary Tract Disease
   • Intestinal Obstruction
3. 3

   Trauma and Critical Care

   3 topics

   • Primary and Secondary Survey (ATLS)
   • Head and Abdominal Trauma
   • Burns Management
4. 4

   Orthopedics

   3 topics

   • Fractures and Dislocations
   • Bone and Joint Infections
   • Common Orthopedic Disorders
5. 5

   Urology

   3 topics

   • Urinary Stones
   • Benign Prostatic Hyperplasia
   • Urological Malignancies
6. 6

   Ophthalmology

   3 topics

   • Cataract and Glaucoma
   • Red Eye and Conjunctivitis
   • Diabetic Retinopathy
7. 7

   Otorhinolaryngology (ENT)

   3 topics

   • Otitis Media and Hearing Loss
   • Sinusitis and Epistaxis
   • Tonsillitis and Pharyngeal Disorders
8. 8

   Anesthesia and Surgical Oncology

   2 topics

   • Principles of Anesthesia
   • Common Surgical Malignancies

Surgery and Allied flashcards for PMDC National Licensing Examination

18 of 68 cards from the Surgery and Allied deck — real questions with worked answers.

1. Name the four classic phases of wound healing in order.

   1) Hemostasis (immediate), 2) Inflammation (days 1-4), 3) Proliferation/Fibroplasia (day 4 to ~3 weeks), 4) Maturation/Remodeling (3 weeks to 1+ year).

2. What is the difference between healing by primary, secondary, and tertiary (delayed primary) intention?

   Primary: clean wound edges approximated directly (sutured). Secondary: wound left open to heal by granulation, contraction and epithelialization. Tertiary: wound left open initially (often for contamination) then closed surgically after a few days.

3. Which collagen type predominates in early granulation tissue and which predominates in the mature remodeled scar?

   Type III collagen predominates early; it is progressively replaced by Type I collagen during remodeling (normal skin ratio Type I:III ~ 4:1).

4. List the key local and systemic factors that impair wound healing.

   Local: infection, ischemia/poor perfusion, foreign body, hematoma, mechanical tension, radiation. Systemic: diabetes, malnutrition (low protein, vitamin C/A, zinc), corticosteroids, smoking, advanced age, uremia, immunosuppression.

5. Which vitamin deficiency specifically impairs collagen cross-linking, and what is the role of vitamin A in steroid-impaired wounds?

   Vitamin C (ascorbic acid) deficiency impairs collagen hydroxylation/cross-linking. Vitamin A reverses the inhibitory effect of corticosteroids on wound healing.

6. Define a surgical site infection (SSI) by timing per CDC criteria.

   Infection occurring within 30 days of surgery (or within 90 days if a prosthesis/implant is placed), classified as superficial incisional, deep incisional, or organ/space.

7. Classify surgical wounds by contamination and give approximate infection rates.

   Clean (~1-2%), Clean-contaminated (~3-11%, controlled entry into a hollow viscus), Contaminated (~10-17%, gross spillage or fresh trauma), Dirty/infected (>27%, established infection or perforated viscus).

8. What organism classically causes gas gangrene, and what is its hallmark and treatment?

   Clostridium perfringens; hallmark is crepitus from subcutaneous gas with myonecrosis and a sweet/foul odor. Treatment: urgent surgical debridement, high-dose penicillin + clindamycin, and supportive care (consider hyperbaric oxygen).

9. What is the classic timing and likely organism for fever appearing within the first 24-48 hours after surgery with a spreading cellulitis?

   Early necrotizing soft tissue infection from group A Streptococcus (Streptococcus pyogenes) or Clostridium - requires urgent surgical exploration/debridement.

10. What is the total body water as a percentage of body weight, and how is it distributed between intracellular and extracellular compartments?

    Total body water ~60% of body weight (in adult males). Two-thirds is intracellular (~40% body weight) and one-third is extracellular (~20%), of which ~3/4 is interstitial and ~1/4 is plasma/intravascular.

11. State the daily maintenance fluid requirement using the 4-2-1 rule for hourly rate.

    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. (e.g. 70 kg = 40 + 20 + 50 = 110 mL/hr).

12. What are the normal daily maintenance requirements for sodium and potassium in an adult?

    Sodium ~1-2 mmol/kg/day (about 70-140 mmol) and potassium ~0.5-1 mmol/kg/day (about 40-80 mmol).

13. Compare the composition trend of upper vs lower GI fluid losses for replacement planning.

    Gastric loss is rich in H+, Cl-, K+ (causes hypokalemic hypochloremic metabolic alkalosis). Lower GI/biliary/pancreatic/diarrheal losses are rich in HCO3- and K+ (cause metabolic acidosis and hypokalemia).

14. What ECG changes are seen in hyperkalemia, and what is the immediate cardioprotective treatment?

    Peaked T waves, then widened QRS, flattened P waves, sine-wave pattern. Immediate cardiac stabilization is IV calcium gluconate; then shift K+ into cells with insulin+glucose, beta-agonists, bicarbonate; then remove with diuretics/resins/dialysis.

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

    A potentially fatal shift of fluids/electrolytes when feeding a malnourished/starved patient; hallmark is severe hypophosphatemia (also hypokalemia, hypomagnesemia, thiamine deficiency). Prevent by starting feeds slowly with electrolyte/thiamine supplementation.

16. When is enteral nutrition preferred over parenteral, and what is the key principle?

    Enteral is preferred whenever the gut is functional ('if the gut works, use it') because it maintains mucosal integrity, reduces bacterial translocation, and lowers infection/cost. TPN is reserved for non-functioning or inaccessible GI tracts.

17. Define shock and name the four major categories.

    Shock is inadequate tissue perfusion/oxygen delivery to meet metabolic demand. Categories: Hypovolemic, Cardiogenic, Obstructive, and Distributive (septic, anaphylactic, neurogenic).

18. Give the hemodynamic profile (CVP/preload, cardiac output, SVR) for hypovolemic, cardiogenic, and septic (warm) shock.

    Hypovolemic: low preload, low CO, high SVR. Cardiogenic: high preload, low CO, high SVR. Septic (early/warm): low/normal preload, high CO, low SVR.

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