Professional and Linguistic Assessments Board (PLAB) Surgery, Trauma and Perioperative Care Syllabus

Surgery, Trauma and Perioperative 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, Trauma and Perioperative Care in Professional and Linguistic Assessments Board (PLAB), not a summary of it.

1. 1

   General and Gastrointestinal Surgery

   4 topics

   • Acute Abdomen
     • Appendicitis and diverticulitis
     • Bowel obstruction and perforation
     • Mesenteric ischaemia
   • Hernias
     • Inguinal and femoral hernias
     • Strangulation and incarceration
   • Hepatobiliary Surgery
     • Cholecystitis and biliary colic
     • Obstructive jaundice
   • Anorectal Conditions
     • Haemorrhoids and fissures
     • Perianal abscess and fistula
2. 2

   Trauma and Emergency Surgery

   4 topics

   • Primary Survey and ATLS Principles
     • Airway with cervical spine control
     • Breathing and circulation assessment
     • Disability and exposure
   • Head and Spinal Injury
     • NICE head injury CT criteria
     • Spinal immobilisation
   • Thoracic and Abdominal Trauma
     • Tension pneumothorax and haemothorax
     • Major haemorrhage protocol
   • Burns
     • Surface area estimation and fluid resuscitation
     • Referral criteria and airway burns
3. 3

   Vascular and Urological Surgery

   4 topics

   • Peripheral Arterial Disease
     • Intermittent claudication and critical limb ischaemia
     • Acute limb ischaemia
   • Aortic Aneurysm
     • Ruptured AAA recognition
     • Screening programme
   • Urological Emergencies
     • Testicular torsion
     • Acute urinary retention
     • Renal and ureteric colic
   • Urological Cancers
     • Haematuria assessment and referral
     • Prostate and bladder cancer
4. 4

   Orthopaedics and Musculoskeletal Trauma

   4 topics

   • Fractures
     • Common adult fractures and management principles
     • Compartment syndrome
     • Neurovascular assessment
   • Joint Disorders
     • Septic arthritis
     • Osteomyelitis
   • Back and Spine
     • Cauda equina syndrome
     • Mechanical low back pain red flags
   • Paediatric Orthopaedics
     • Developmental dysplasia of the hip
     • Slipped capital femoral epiphysis
5. 5

   Perioperative and Anaesthetic Care

   4 topics

   • Preoperative Assessment
     • ASA grading and risk stratification
     • Medication management around surgery
   • Postoperative Complications
     • Postoperative fever and infection
     • Ileus and anastomotic leak
   • Pain and Fluid Management
     • Analgesic ladder
     • Perioperative fluid prescribing
   • Venous Thromboembolism Prophylaxis
     • Risk assessment and mechanical measures
     • Pharmacological prophylaxis

Surgery, Trauma and Perioperative Care flashcards for Professional and Linguistic Assessments Board (PLAB)

21 of 51 cards from the Surgery, Trauma and Perioperative Care deck — real questions with worked answers.

1. What is the classic triad of clinical features suggesting acute mesenteric ischaemia?

   Severe central abdominal pain out of proportion to clinical signs, rapid onset, and an embolic source (e.g. atrial fibrillation). Often accompanied by metabolic acidosis with raised lactate.

2. How do you distinguish small bowel obstruction from large bowel obstruction on an abdominal X-ray?

   Small bowel: central loops, valvulae conniventes crossing the full lumen, dilatation $>3$ cm. Large bowel: peripheral loops, haustra that do not fully cross the lumen, dilatation $>6$ cm (caecum $>9$ cm).

3. What is the typical clinical progression of pain in acute appendicitis?

   Initial central/periumbilical colicky pain (visceral, T10 dermatome) that later localises and becomes sharp in the right iliac fossa at McBurney's point (somatic, parietal peritoneum involvement).

4. Define a Richter's hernia and explain why it is dangerous.

   A hernia in which only part of the bowel circumference (antimesenteric border) becomes strangulated. It is dangerous because strangulation/necrosis can occur without features of obstruction, delaying diagnosis.

5. Contrast the anatomy distinguishing an indirect from a direct inguinal hernia relative to the inferior epigastric vessels.

   Indirect hernia passes through the deep inguinal ring lateral to the inferior epigastric vessels (and can extend into the scrotum). Direct hernia pushes through the weak posterior wall (Hesselbach's triangle) medial to the vessels.

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

   Medially the lateral border of rectus abdominis, laterally the inferior epigastric vessels, and inferiorly the inguinal ligament. Direct inguinal hernias protrude through this triangle.

7. State the components of Charcot's triad and Reynolds' pentad in ascending cholangitis.

   Charcot's triad: fever (with rigors), right upper quadrant pain, jaundice. Reynolds' pentad adds hypotension and confusion/altered mental state, indicating suppurative cholangitis.

8. What is Courvoisier's law?

   In the presence of painless jaundice, a palpable (enlarged, non-tender) gallbladder is unlikely to be due to gallstones; malignancy (e.g. pancreatic or biliary cancer) should be suspected instead.

9. What is Murphy's sign and what does it indicate?

   Arrest of inspiration on deep palpation of the right upper quadrant (right subcostal) due to pain as the inflamed gallbladder descends onto the examining hand. It indicates acute cholecystitis and should be negative on the left side.

10. Differentiate the typical presentation of an anal fissure from haemorrhoids.

    Anal fissure: severe, sharp pain during and after defecation with bright red bleeding, often a posterior midline tear. Haemorrhoids: usually painless bright red bleeding (unless thrombosed), with pruritus and prolapse.

11. What is the first-line management of a chronic anal fissure?

    Conservative measures (high-fibre diet, stool softeners, increased fluids, sitz baths) plus topical glyceryl trinitrate (GTN) or diltiazem to relax the internal sphincter and improve blood flow. Botulinum toxin or lateral internal sphincterotomy if refractory.

12. List the ABCDE sequence of the ATLS primary survey.

    A – Airway with cervical spine protection; B – Breathing and ventilation; C – Circulation with haemorrhage control; D – Disability (neurological status, GCS, pupils); E – Exposure and Environment control (prevent hypothermia).

13. What are the six immediately life-threatening thoracic injuries identified in the primary survey ('breathing' killers)?

    Airway obstruction, tension pneumothorax, open pneumothorax (sucking chest wound), massive haemothorax, flail chest, and cardiac tamponade. (Mnemonic: ATOM-FC.)

14. How is a tension pneumothorax managed before a chest drain is placed?

    Immediate needle decompression — large-bore cannula in the 2nd intercostal space, midclavicular line (or 4th/5th space anterior axillary line per newer guidance), followed by definitive chest drain insertion. It is a clinical diagnosis; do not wait for imaging.

15. State the components and scoring range of the Glasgow Coma Scale.

    Eye opening (1–4), Verbal response (1–5), Motor response (1–6). Total ranges from 3 (deep coma) to 15 (fully alert). A GCS $\leq 8$ indicates the need to consider definitive airway protection (intubation).

16. What is Cushing's triad and what does it signify?

    Hypertension (widening pulse pressure), bradycardia, and irregular respirations. It is a late sign of raised intracranial pressure and impending brain herniation.

17. Differentiate an extradural from a subdural haematoma on CT and clinical course.

    Extradural: biconvex (lentiform) hyperdensity, does not cross suture lines, classic lucid interval, often from middle meningeal artery rupture. Subdural: crescent-shaped, crosses suture lines, from bridging veins, common in elderly/alcoholics with gradual onset.

18. What is Beck's triad of cardiac tamponade?

    Hypotension, muffled (distant) heart sounds, and raised jugular venous pressure (distended neck veins). Pulsus paradoxus may also be present. Managed with pericardiocentesis.

19. What defines a massive haemothorax and how is it managed?

    $>1500$ mL of blood drained immediately from a chest drain, or ongoing loss $>200$ mL/hour for 2–4 hours. Management: large-bore chest drain, fluid/blood resuscitation, and urgent thoracotomy.

20. State the Wallace 'rule of nines' for estimating adult burn surface area.

    Head and neck 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%. The patient's palm (including fingers) approximates 1% of total body surface area.

21. State the Parkland formula for fluid resuscitation in burns and how it is administered.

    $\text{Volume} = 4 \,\text{mL} \times \text{weight (kg)} \times \%\,\text{TBSA burned}$, using Hartmann's solution over 24 hours. Half is given in the first 8 hours from the time of injury and the remainder over the next 16 hours.

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