Arab Board Surgery Final Written common mistakes
Arab Board Surgery Final Written · Understand the traps and how to avoid them.
In trauma vignettes, ordering CT or definitive fracture/abdominal management before completing the primary survey and correcting immediate life threats.
A dramatic wound, obvious deformity, or familiar injury pattern anchors attention and feels like the next logical step.
What to do instead
Force a verbal ABCDE sequence for every trauma stem: airway protection, breathing/ventilation, circulation with haemorrhage control, disability, exposure. Commit to the next life-saving action before secondary-survey imaging.
Prescribing a fixed postoperative fluid order such as 3 L of crystalloid per day without calculating maintenance, deficit, and ongoing losses or reassessing volume status.
Habitual ward protocols replace individualised perioperative fluid and electrolyte reasoning.
What to do instead
For each fluid question, state maintenance requirement, existing deficit, ongoing losses, and current volume status; then choose tonicity and rate, and specify reassessment with urine output, weight, and electrolytes.
Labeling an obstructed hernia or bowel obstruction as reducible/non-strangulated and delaying surgery despite focal tenderness, pain out of proportion, or rising inflammatory markers.
Candidates rely on fever or absent bowel sounds as required signs and are reassured by a reducible lump or plain film.
What to do instead
Treat severe pain, tenderness, skin changes, leukocytosis, lactic acidosis, or clinical deterioration as strangulation warning signs; state that these mandate urgent surgical exploration rather than further observation.
In ascending cholangitis, arranging ERCP before resuscitation and antibiotics, or in painless obstructive jaundice, failing to include pancreatic/periampullary malignancy in the workup.
The biliary obstruction is visually obvious on imaging, so the sequence of sepsis control and malignancy exclusion is skipped.
What to do instead
State antibiotics and haemodynamic resuscitation first, then urgent biliary drainage for sepsis; for painless jaundice, state contrast-enhanced pancreatic-protocol imaging and CA19-9/tissue diagnosis before assuming benign stones.
Discharging a palpable breast lump after ultrasound alone, especially in a young woman, without cytology or core biopsy.
Age and a seemingly benign ultrasound appearance create anchoring bias toward fibroadenoma.
What to do instead
Apply triple assessment explicitly: clinical examination, imaging appropriate to age, and tissue diagnosis. Require concordant benign results before discharge; otherwise refer for core biopsy.
Managing rest pain or tissue loss as claudication and prescribing exercise or reassurance instead of urgent revascularisation assessment.
The absence of palpable pulses is noted, but the distinction between lifestyle-limiting claudication and critical limb-threatening ischaemia is not applied.
What to do instead
Ask specifically about night/rest pain, ulcers, and gangrene; classify as chronic limb-threatening ischaemia and state urgent vascular referral, imaging, and revascularisation rather than exercise therapy.
Deciding on cancer resection from the primary tumour appearance alone, without completing TNM staging or documenting multidisciplinary team discussion.
The visible or palpable primary tumour dominates the clinical picture and encourages premature operative planning.
What to do instead
Before choosing treatment, list T, N, and M category evidence, required staging imaging, histology, and fitness; state the MDT recommendation and how stage changes management.
In septic shock, waiting for cultures before giving antibiotics, or giving repeated fluid boluses without reassessing perfusion and fluid responsiveness.
Ritual completion of investigation first and fear of missing a pathogen outweigh time-critical resuscitation.
What to do instead
State that cultures are taken promptly but must not delay antibiotics; give antibiotics within the first hour, use balanced crystalloid with defined reassessment, and escalate vasopressors if perfusion remains inadequate.
Using adult maintenance fluid regimens in children, or treating neonatal bilious vomiting as feed intolerance and delaying surgical referral.
Adult ward habits and benign feeding problems are overgeneralised to paediatric and neonatal presentations.
What to do instead
Use weight-based isotonic maintenance fluid with appropriate dextrose for children, and treat bilious vomiting in a neonate as malrotation/volvulus until excluded, requiring immediate surgical assessment and imaging.
Focusing only on the named general surgical problem and overlooking red flags from allied specialties, such as compartment syndrome after limb injury or cauda equina symptoms in back pain.
Candidates compartmentalise by specialty and do not screen for time-critical neurovascular or orthopaedic emergencies.
What to do instead
Add a fixed red-flag screen for relevant stems: neurovascular status, pain out of proportion, progressive neurology, and sphincter disturbance; state the urgent referral or decompression pathway.