United States Medical Licensing Examination (USMLE) Surgery, Emergency, and Acute Care Syllabus

Surgery, Emergency, and Acute 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, and Acute Care in United States Medical Licensing Examination (USMLE), not a summary of it.

1. 1

   Preoperative and Perioperative Care

   4 topics

   • Preoperative risk assessment
   • Fluid, electrolyte, and nutrition management
   • Wound healing and surgical site infection
   • Postoperative complications
     • Fever, ileus, and DVT prophylaxis
2. 2

   Trauma and Acute Abdomen

   4 topics

   • Primary and secondary trauma survey
     • ATLS principles
   • Hemorrhagic shock and resuscitation
   • Acute abdomen differential
   • Appendicitis, obstruction, and perforation
3. 3

   General and Subspecialty Surgery

   4 topics

   • Hepatobiliary and pancreatic surgery
   • Colorectal and hernia repair
   • Vascular and endocrine surgery
   • Breast and soft tissue disease
4. 4

   Emergency Medicine

   5 topics

   • Cardiac and respiratory arrest
     • ACLS and resuscitation
   • Toxicologic emergencies and overdose
   • Environmental and burn injury
   • Acute neurologic emergencies
   • Triage and disaster medicine

Surgery, Emergency, and Acute Care flashcards for United States Medical Licensing Examination (USMLE)

19 of 55 cards from the Surgery, Emergency, and Acute Care deck — real questions with worked answers.

1. What revised cardiac risk index (RCRI) factors predict major cardiac complications in noncardiac surgery?

   High-risk surgery, ischemic heart disease, history of CHF, history of cerebrovascular disease, insulin-dependent diabetes, and preoperative creatinine >2.0 mg/dL. Risk rises with each factor present.

2. What functional capacity threshold (in METs) suggests a patient can tolerate surgery without further cardiac testing?

   4 METs or greater (e.g., climbing a flight of stairs or walking up a hill). Inability to reach 4 METs warrants further evaluation in patients with risk factors.

3. By how long before elective surgery should a patient stop smoking to meaningfully reduce pulmonary complications?

   At least 4-8 weeks; cessation under 4 weeks may transiently increase secretions. Even short-term cessation reduces carboxyhemoglobin within hours to days.

4. What is the formula for maintenance IV fluid rate using the 4-2-1 rule?

   4 mL/kg/hr for first 10 kg, plus 2 mL/kg/hr for next 10 kg, plus 1 mL/kg/hr for each kg above 20. (e.g., 70 kg = 40+20+50 = 110 mL/hr.)

5. How do you correct serum sodium for hyperglycemia?

   Add 1.6-2.4 mEq/L to measured sodium for every 100 mg/dL glucose above 100 mg/dL. This reveals true sodium masked by osmotic dilution.

6. What is refeeding syndrome and which electrolyte abnormality is its hallmark?

   A potentially fatal shift seen when feeding malnourished patients; insulin surge drives electrolytes intracellularly. Hallmark is hypophosphatemia, with hypokalemia and hypomagnesemia. Replete phosphate and feed slowly.

7. What is the daily protein requirement for a critically ill or post-surgical catabolic patient?

   Approximately 1.5-2.0 g/kg/day (vs ~0.8 g/kg/day for healthy adults), to offset catabolism and support wound healing.

8. List the four sequential phases of wound healing in order.

   Hemostasis (immediate), inflammation (days 1-3), proliferation (days 3 to weeks; granulation, collagen III, angiogenesis), and remodeling/maturation (weeks to months; collagen III replaced by type I).

9. By what postoperative day do surgical site infections (SSIs) typically present, and which clostridial/strep infections appear within the first 24-48 hours?

   Most SSIs appear postoperative days 5-7. Clostridium perfringens and Group A Streptococcus cause early (within 24-48 hr) aggressive necrotizing infections.

10. What CDC wound classification corresponds to a 'clean-contaminated' wound and its approximate infection risk?

    Class II: controlled entry into respiratory, GI, or GU tract without unusual contamination; infection risk roughly 3-11%. (Class I clean ~1-2%, Class III contaminated, Class IV dirty/infected.)

11. When should prophylactic antibiotics be administered relative to surgical incision?

    Within 60 minutes before incision (within 120 minutes for vancomycin or fluoroquinolones), to ensure adequate tissue levels at the time of incision.

12. What is the most common cause of fever on postoperative days 1-2, and the classic '5 Ws' mnemonic?

    Atelectasis is classic for POD 1-2. The 5 Ws by timing: Wind (atelectasis/pneumonia, 1-2), Water (UTI, 3-5), Walking (DVT, 4-6), Wound (infection, 5-7), Wonder drugs/Wonder-what-else (drug fever/abscess, >7).

13. What is the most common cause of postoperative small bowel obstruction in a patient with prior abdominal surgery?

    Adhesions. They are the leading cause of SBO overall in patients with previous abdominal operations.

14. How is postoperative ileus distinguished from mechanical small bowel obstruction on imaging?

    Ileus shows diffusely dilated bowel with air throughout including the colon/rectum and no transition point. Mechanical obstruction shows a discrete transition point with proximal dilation and distal collapse.

15. What are the components of the primary survey (ABCDE) in trauma?

    Airway with cervical spine protection, Breathing/ventilation, Circulation with hemorrhage control, Disability (neuro/GCS), and Exposure/environmental control (undress and prevent hypothermia).

16. What does the secondary survey in trauma consist of?

    A head-to-toe physical exam plus full history (AMPLE: Allergies, Medications, Past history, Last meal, Events), performed only after the primary survey and resuscitation, including back/log roll and rectal exam as indicated.

17. Name the immediately life-threatening chest injuries identified in the primary survey ('lethal six' / breathing threats).

    Airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, flail chest with pulmonary contusion, and cardiac tamponade.

18. What are the four classes of hemorrhagic shock by percent blood loss and the first vital sign to change?

    Class I <15%, Class II 15-30%, Class III 30-40%, Class IV >40%. Tachycardia and narrowed pulse pressure appear first (Class II); hypotension is a late sign (Class III-IV).

19. What is the modern massive transfusion protocol ratio of products?

    1:1:1 ratio of packed red blood cells to fresh frozen plasma to platelets, approximating whole blood and reducing trauma-induced coagulopathy.

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