CSHK Part 2 EMQ cheat sheet

Wound healing phases: haemostasis (minutes), inflammation (days 0-3, neutrophils then macrophages), proliferation (days 3-21, fibroblasts, collagen III, angiogenesis), remodelling (weeks to months, collagen III replaced by type I; tensile strength ~80% of original at best).

Suture materials: monofilament (less infection risk) vs braided (better handling); absorbable (catgut, Vicryl/polyglactin, Monocryl/poliglecaprone, PDS/polydioxanone) vs non-absorbable (silk, nylon, polypropylene, steel). Mass closure uses suture length to wound length ratio of at least 4:1.

Diathermy: monopolar requires a return plate and is unsafe in narrow appendages or with implanted devices; bipolar is preferred for fine work and patients with pacemakers.

Antibiotic prophylaxis is given within 60 minutes of incision (120 minutes for vancomycin/fluoroquinolones); repeat intraoperatively at twice the drug half-life or after major blood loss.

Sterile technique and WHO surgical safety checklist reduce wrong-site surgery and retained items; swab and instrument counts are mandatory for cavity surgery.

Nutrition: basal energy requirement ~25-30 kcal/kg/day; surgical patients catabolise up to 1-2 g/kg/day protein. Enteral feeding is preferred to parenteral (preserves gut mucosa, fewer septic complications).

Fluid compartments: total body water ~60% of lean weight; intracellular ~40%, extracellular ~20% (interstitial 15%, plasma 5%). Maintenance ~30-35 mL/kg/day plus replacement of losses.

Informed consent requires capacity, disclosure of material risks, and voluntariness; document discussion of alternatives and consequences of refusal.

Acute cholecystitis: RUQ pain, Murphy sign, fever, leucocytosis; first-line imaging is transabdominal ultrasound (wall thickening >3 mm, pericholecystic fluid); early laparoscopic cholecystectomy within 72 hours is preferred.

Acute appendicitis: migration of pain to RIF, McBurney point tenderness, Alvarado score; CT or ultrasound confirms in equivocal cases; laparoscopic appendectomy is standard.

Obstructive jaundice: painless jaundice with weight loss suggests pancreatic head or periampullary malignancy; Courvoisier sign is a palpable non-tender gallbladder. First-line imaging is ultrasound then CT/MRCP.

Small bowel obstruction: colicky pain, vomiting, distension, absolute constipation; erect CXR/abdominal X-ray shows dilated loops with air-fluid levels; CT identifies transition point and strangulation.

Breast cancer triple assessment: clinical examination, imaging (mammography plus ultrasound), and core biopsy with histology and receptor status (ER/PR/HER2). Sentinel node biopsy for clinically node-negative axilla.

Thyroid: solitary nodule >1 cm warrants ultrasound and FNA; papillary carcinoma spreads lymphatically, follicular spreads haematogenously; medullary arises from parafollicular C cells with raised calcitonin.

Colorectal cancer: right-sided tumours present with iron-deficiency anaemia and mass; left-sided with obstruction and altered bowel habit. Staging by CT chest/abdomen/pelvis and MRI for rectal cancer.

Peripheral arterial disease: ABPI <0.9 suggests disease; critical limb ischaemia is rest pain, ulceration, or gangrene with ABPI <0.4 or ankle pressure <50 mmHg; urgent revascularisation is required.

Preoperative risk: ASA physical status, revised cardiac risk index (RCRI) predicts major cardiac events; functional capacity <4 METs warrants further assessment before major surgery.

VTE prophylaxis: risk-assess every surgical admission; mechanical (TED stockings, intermittent pneumatic compression) plus LMWH unless contraindicated; restart after high bleeding-risk procedures per protocol.

Enhanced recovery after surgery (ERAS): carbohydrate loading, avoidance of prolonged fasting, opioid-sparing multimodal analgesia, early mobilisation and early oral intake, normothermia and euvolaemia.

Postoperative fever: wind (atelectasis/pneumonia, day 1-2), water (urinary, day 3-5), wound (day 5-7), walk (DVT), wonder drugs (drug fever), and 'what' (abscess/anastomotic leak).

Sepsis: use qSOFA (RR >=22, altered mentation, SBP <=100) for screening; sepsis-3 defines organ dysfunction by SOFA score; give broad-spectrum antibiotics within 1 hour and 30 mL/kg crystalloid for hypotension or lactate >=4.

Acute kidney injury: KDIGO stages by creatinine rise and urine output; prerenal causes respond to fluid, obstructive causes need catheter or nephrostomy; avoid nephrotoxins.

Anastomotic leak presents with tachycardia, fever, pain, peritonitis, or rising CRP; CT with contrast and urgent surgical review are indicated.

Surgical site infection (SSI): superficial (skin/subcutaneous), deep (fascia/muscle), organ/space; wound dehiscence with 'pink serosanguineous' discharge suggests impending fascial failure.

ATLS primary survey: catastrophic haemorrhage control, Airway with c-spine protection, Breathing and ventilation, Circulation with haemorrhage control, Disability (GCS), Exposure with prevention of hypothermia.

Haemorrhagic shock classes: class I (<15% loss), II (15-30%, tachycardia), III (30-40%, hypotension, altered mentation), IV (>40%, profound hypotension). Blood, not crystalloid, is preferred for class III/IV.

Massive transfusion protocol: balanced ratios approaching 1:1:1 (PRBC:FFP:platelets), with tranexamic acid within 3 hours of injury; permissive hypotension until haemorrhage control.

FAST ultrasound in trauma assesses pericardial, perihepatic, perisplenic, and pelvic free fluid; positive FAST with haemodynamic instability mandates laparotomy.

Blunt abdominal trauma: CT with IV contrast is the investigation of choice in the stable patient; diagnostic peritoneal lavage or laparotomy for unstable patients.

Acute limb ischaemia: 6 Ps (pain, pallor, pulselessness, paraesthesia, paralysis, perishing cold); Rutherford classification guides urgency; IV heparin and urgent vascular referral.

Perforated viscus: board-like rigidity, free air on erect CXR or CT; resuscitate then emergency laparotomy or laparoscopic repair with peritoneal lavage.

Acute pancreatitis: diagnosis needs 2 of 3 (typical pain, amylase/lipase >3x upper limit, imaging); severity assessed by modified Glasgow or APACHE II; early ERCP for concurrent cholangitis.

Postoperative nausea and vomiting (PONV): identify risk factors (female, non-smoker, history of PONV, opioids); multimodal prophylaxis with ondansetron, dexamethasone, and droperidol or cyclizine.

Hypotension after surgery: consider hypovolaemia, haemorrhage, sepsis, myocardial infarction, pulmonary embolism, and epidural/anaesthetic effects; check ECG, troponin, lactate, and bedside echo.

Oliguria (<0.5 mL/kg/h): check catheter patency, assess fluid status, exclude obstruction with bladder scan; distinguish prerenal, renal, and postrenal causes.

Respiratory complications: atelectasis (most common early), pneumonia, aspiration, and pulmonary embolism; incentive spirometry, early mobilisation, and adequate analgesia reduce risk.

Surgical drains: closed suction drains reduce infection risk; remove as soon as output is low (<30-50 mL/day) to reduce retrograde infection and patient discomfort.

Pain management: multimodal (paracetamol, NSAIDs where safe, opioids, regional blocks); PCA and epidural for major abdominal/thoracic surgery; monitor for opioid-induced respiratory depression.

Delirium in surgical patients: assess with 4AT or CAM; common in elderly with hip fracture; treat underlying cause (pain, hypoxia, infection, constipation, drugs) and avoid restraint.

Discharge criteria: adequate analgesia on oral medication, tolerating diet, mobilising, normal observations, and clear written follow-up and wound-care instructions.

Trauma secondary survey: head-to-toe examination with AMPLE history (Allergies, Medications, Past history, Last meal, Events); reassess ABCDE frequently.

Head injury: GCS <=8 warrants intubation; CT head for any head injury on anticoagulants, focal deficit, or GCS drop; avoid hypotension and hypoxia to prevent secondary brain injury.

Tension pneumothorax: clinical diagnosis (tracheal deviation away, absent breath sounds, distended neck veins, hypotension); immediate needle decompression then chest drain.

Open pneumothorax: three-sided dressing or chest seal; if deteriorating, intubate and place chest drain.

Flail chest and pulmonary contusion: analgesia, oxygen, physiotherapy; ventilatory support if respiratory failure develops.

Pelvic fracture: high-energy mechanism with haemodynamic instability; apply pelvic binder at level of greater trochanters, avoid repeated log-rolling, and consider angioembolisation.

Burns: Parkland formula 4 mL/kg/%TBSA crystalloid in first 24 hours, half in first 8 hours; use Lund-Browder for accurate TBSA in children; airway assessment for inhalation injury.

Damage control surgery: abbreviated laparotomy to control haemorrhage and contamination, temporary abdominal closure, ICU correction of hypothermia, acidosis, and coagulopathy, then definitive surgery.

Sepsis six within 1 hour: oxygen, blood cultures, IV antibiotics, IV fluids, lactate measurement, and urine output monitoring.

Acute respiratory distress syndrome (ARDS): Berlin criteria (acute onset, bilateral infiltrates, PaO2/FiO2 <=300 on PEEP >=5); lung-protective ventilation with tidal volume 6 mL/kg predicted body weight.

Acute compartment syndrome: pain out of proportion, pain on passive stretch, tense compartment; pressure >30 mmHg or delta pressure <30 mmHg warrants urgent fasciotomy; pulses may remain palpable.

Rhabdomyolysis: raised CK, myoglobinuria, AKI risk; aggressive IV fluids and monitor electrolytes (hyperkalaemia, hyperphosphataemia).

Bowel obstruction complications: strangulation, perforation, and dehydration; signs include fever, tachycardia, peritonism, and rising lactate; urgent surgery if compromised.

Gastrointestinal bleeding: resuscitate, IV PPI for suspected upper GI bleed, urgent endoscopy within 24 hours; variceal bleeding needs terlipressin and antibiotics.

Acute mesenteric ischaemia: pain out of proportion to examination, raised lactate, AF or embolic source; CT angiography is diagnostic; revascularisation within hours is critical.

Postoperative bleeding: tachycardia and falling urine output may precede hypotension; check drain output, Hb, and consider re-exploration if unstable.

Fluid resuscitation: balanced crystalloids (Hartmann's, Plasma-Lyte) preferred to 0.9% saline to reduce hyperchloraemic acidosis; avoid starch solutions.

Blood transfusion: restrictive threshold Hb <70 g/L (80 g/L in cardiac disease); one unit at a time and reassess; check for transfusion reactions (fever, haemolysis, urticaria, TRALI).

Ventilator-associated pneumonia prevention: head-up 30-45 degrees, daily sedation hold, oral chlorhexidine, subglottic suction, and avoid unnecessary circuit changes.

Central line-associated bloodstream infection prevention: full barrier precautions, chlorhexidine skin antisepsis, and daily review of line necessity.

Acute coronary syndrome in surgical patients: troponin rise with ischaemic symptoms or ECG changes; cardiology input and consider delaying non-urgent surgery.

Hypothermia in theatre: forced-air warming, warmed fluids, and raised ambient temperature; hypothermia impairs coagulation and increases SSI and cardiac events.

Perioperative glycaemic control: target 6-10 mmol/L; hyperglycaemia worsens infection and outcomes; use variable-rate IV insulin in critical illness.

ICU sedation: target RASS 0 to -2; daily awakening trials and spontaneous breathing trials shorten ventilation; analgosedation preferred.

Surgical infection: distinguish contamination, colonisation, and infection; source control (drainage, debridement) is as important as antibiotics.

Antibiotic stewardship: culture before starting, review at 48-72 hours, de-escalate based on sensitivities, and stop when infection is excluded.

Surgical oncology margins: R0 (no tumour at margin), R1 (microscopic), R2 (macroscopic); aim for R0; sentinel node and lymphadenectomy for staging.

Stoma care: end vs loop; high-output stoma (>1.5 L/day) risks dehydration and electrolyte loss; manage with antimotility agents and fluid replacement.

Hernia: tension-free mesh repair reduces recurrence; strangulation risk is higher with narrow-neck femoral hernias; emergency presentation warrants urgent surgery.

Bariatric surgery: indications BMI >=40 or >=35 with comorbidity; procedures include sleeve gastrectomy and Roux-en-Y gastric bypass; monitor for dumping, micronutrient deficiency, and anastomotic leak.

Surgical audit and governance: morbidity and mortality meetings, WHO checklist, and root-cause analysis of adverse events drive quality improvement.

Basic surgical skills: correct instrument handling, knot tying, and aseptic technique; sharp injuries require immediate washing and PEP assessment.

Upper GI bleeding: variceal (portal hypertension) vs non-variceal (peptic ulcer, Mallory-Weiss); resuscitate, PPI infusion, and endoscopy with adrenaline injection, clips, or bands.

Peptic ulcer disease: H. pylori eradication reduces recurrence; perforation presents with sudden severe pain and free air; treat with omental patch (Graham) and washout.

Inflammatory bowel disease surgery: ulcerative colitis - proctocolectomy with ileal pouch; Crohn disease - conservative, strictureplasty, resection for complications; abscess drainage first.

Diverticular disease: uncomplicated diverticulitis managed with antibiotics and diet; Hinchey classification guides surgery for perforation and peritonitis.

Hepatobiliary: gallstone disease is the commonest cause of acute pancreatitis; ERCP for choledocholithiasis with cholangitis or obstruction.

Urology: acute urinary retention needs catheterisation; testicular torsion is a surgical emergency requiring urgent exploration and bilateral fixation.

Vascular: abdominal aortic aneurysm repair indicated if >5.5 cm or rapid growth; ruptured AAA presents with back pain, hypotension, and pulsatile mass.

Breast abscess: ultrasound and aspiration or incision and drainage; continue breastfeeding where possible; exclude inflammatory cancer if recurrent.

Major haemorrhage: activate protocol early, give tranexamic acid within 3 hours, avoid crystalloid overload, and monitor for hypothermia, acidosis, and coagulopathy (lethal triad).

Abdominal trauma in children: spleen is most commonly injured; non-operative management is preferred in stable patients; FAST and CT used selectively.

Chest trauma: life-threatening injuries include tension pneumothorax, massive haemothorax, cardiac tamponade, flail chest, and airway obstruction; treat in primary survey.

Cardiac tamponade: Beck triad (hypotension, distended neck veins, muffled heart sounds); pericardiocentesis or thoracotomy depending on stability.

Traumatic brain injury: avoid hypoxia and hypotension; maintain CPP; repeat CT if GCS deteriorates; neurosurgical referral for extradural, subdural, or contusion with mass effect.

Spinal injury: immobilise until cleared; use ASIA or neurological assessment; high-dose steroids are not routinely recommended.

Abdominal stab wound: local wound exploration and serial examination; laparotomy for evisceration, peritonitis, or haemodynamic instability.

Tetanus prophylaxis: according to wound type and immunisation history; clean minor wounds in fully immunised patients need no booster.

Preoperative assessment: identify anaemia, malnutrition, uncontrolled diabetes, and cardiorespiratory disease; optimise before elective surgery.

Smoking and alcohol: cessation at least 4 weeks before surgery reduces pulmonary complications; alcohol excess increases bleeding and withdrawal risk.

Perioperative medication: continue beta-blockers and statins; stop clopidogrel 5-7 days before elective surgery unless high thrombotic risk; bridge anticoagulation per protocol.

Postoperative mobilisation: early ambulation reduces VTE, pneumonia, and pressure sores; use incentive spirometry and chest physiotherapy.

Wound care: keep clean and dry; review at 48-72 hours; signs of infection include spreading erythema, purulent discharge, and systemic upset.

Pressure ulcers: risk assessment (Waterlow or Braden); reposition, use pressure-relieving surfaces, and maintain nutrition.

Rehabilitation: early physiotherapy and occupational therapy improve function after major surgery; assess falls risk and home environment before discharge.

Follow-up: clear plan for wound review, histology results, and cancer surveillance; document in discharge summary.

Shock types: hypovolaemic (haemorrhage, burns), cardiogenic (MI, arrhythmia), distributive (sepsis, anaphylaxis), obstructive (tamponade, tension pneumothorax); treat cause.

Anaphylaxis: adrenaline 0.5 mg IM (1:1000) into anterolateral thigh, repeat after 5 minutes; oxygen, IV fluids, and antihistamine/steroid as adjuncts.

Local anaesthetic toxicity: perioral tingling, seizures, arrhythmias; stop injection, secure airway, give 20% lipid emulsion (Intralipid) per protocol.

Malignant hyperthermia: triggered by volatile anaesthetics and suxamethonium; hyperthermia, rigidity, rising ETCO2; treat with dantrolene and cooling.

Surgical diathermy safety: avoid alcohol-based skin prep pooling, ensure return electrode contact, and use lowest effective power.

Wound closure: layers closed separately; skin sutures removed at 5-7 days on face, 7-10 days on trunk and limbs; avoid tension.

Suture technique: interrupted vs continuous; continuous closure is faster but interrupted allows drainage and partial removal.

Infection control: hand hygiene, sterile field, and appropriate PPE; MRSA and C. difficile require isolation and specific treatment.

Hernias: inguinal (indirect through deep ring, direct through Hesselbach triangle), femoral (below and lateral to pubic tubercle), umbilical, incisional; repair with mesh for adults.

Testicular examination: painless lump suggests malignancy; scrotal ultrasound and tumour markers (AFP, beta-hCG, LDH); radical inguinal orchidectomy for suspected cancer.

Anal fissure: painful bleeding on defecation; treat with stool softeners and topical GTN or diltiazem; surgery (lateral internal sphincterotomy) for chronic cases.

Haemorrhoids: conservative treatment first; rubber band ligation for grade II-III; surgery for grade IV or failed conservative management.

Perianal abscess: incision and drainage; exclude fistula; recurrent abscess or fistula needs EUA and possible seton.

Acute limb ischaemia vs critical limb ischaemia: acute is sudden with no collaterals; critical is chronic with rest pain and tissue loss; management differs (embolectomy vs bypass).

Varicose veins: duplex ultrasound to assess reflux; endovenous ablation or surgery for symptomatic disease; exclude DVT.

Thyroid surgery complications: recurrent laryngeal nerve injury (hoarseness), hypocalcaemia from parathyroid injury, and haematoma causing airway compromise.

Appendicitis in pregnancy: RLQ pain may be higher; ultrasound then MRI; laparoscopic appendectomy is safe in all trimesters.

Paediatric trauma: children compensate well then deteriorate suddenly; hypotension is a late sign; use weight-based fluid boluses (20 mL/kg).

Elderly trauma: lower physiological reserve; beta-blockers mask tachycardia; liberal CT imaging; early involvement of geriatricians.

Burns fluid resuscitation: urine output target 0.5 mL/kg/h in adults, 1 mL/kg/h in children; avoid over-resuscitation.

Electrical burns: risk of cardiac arrhythmia and deep tissue injury; ECG monitoring and cardiac enzymes; look for exit wounds.

Chemical burns: irrigate copiously with water; do not neutralise; protect staff.

Abdominal trauma in pregnancy: left lateral tilt to avoid inferior vena cava compression; monitor fetus; involve obstetrics.

Mass casualty triage: sort by priority (airway/breathing first); use triage sieve and sort; communicate with incident command.

Postoperative pyrexia: common causes include atelectasis, pneumonia, urinary infection, wound infection, DVT, and drug reaction; investigate based on timing.

Chest infection prevention: stop smoking, chest physiotherapy, adequate analgesia, early mobilisation, and head-up positioning.

Urinary catheter care: remove as soon as possible; use closed drainage; catheter-associated UTI is common; avoid unnecessary catheterisation.

Bowel function: early feeding and mobilisation reduce ileus; chewing gum may help; avoid prolonged opioid use.

Wound dehiscence: risk factors include poor nutrition, infection, raised intra-abdominal pressure, and poor technique; re-suture or manage with dressing.

Seroma and haematoma: common after breast and hernia surgery; aspiration for seroma; evacuation for expanding haematoma.

Nerve injury: positioning and retraction can cause neuropraxia; document pre-existing deficits; most recover spontaneously.

Documentation: accurate operative note, consent, and discharge summary are essential for continuity and medico-legal protection.

Wound classification: clean, clean-contaminated, contaminated, dirty; determines antibiotic prophylaxis and infection risk.

Surgical scrubbing: remove jewellery, use chlorhexidine or povidone-iodine, scrub for 3-5 minutes first time; alcohol rubs are alternatives.

Gowning and gloving: closed gloving technique for sterility; keep hands above waist and within sterile field.

Diathermy and pacemakers: use bipolar where possible; if monopolar, place return electrode away from device and avoid current across chest.

Tourniquet use: document time, limit to 2 hours (or 3 with release); risks include nerve injury, compartment syndrome, and reperfusion injury.

Drains: types include Robinson, corrugated, and suction; remove when output low; document volume and character.

Suturing: choose appropriate needle (cutting vs round bodied); approximate tissue without tension; avoid dead space.

Postoperative analgesia: multimodal with paracetamol, NSAIDs, and opioids; regional blocks reduce opioid requirement.

Acute abdomen: systematic assessment (history, examination, investigations); common causes by quadrant; early surgical review for peritonism.

Bowel obstruction: distinguish small vs large; small bowel obstruction commonest cause is adhesions; large bowel obstruction commonest cause is colorectal cancer.

Acute cholecystitis vs biliary colic: cholecystitis has persistent pain, fever, and leucocytosis; biliary colic is intermittent and settles.

Pancreatitis: commonest causes are gallstones and alcohol; severity scoring; early fluid resuscitation and analgesia; antibiotics only for infected necrosis.

Appendicitis: Alvarado score; imaging in equivocal cases; laparoscopic appendectomy.

Diverticulitis: left iliac fossa pain, fever, leucocytosis; CT for complications; antibiotics for uncomplicated cases.

Ischaemic colitis: pain out of proportion, bloody diarrhoea; CT angiography; usually managed conservatively unless gangrene.

Hernia complications: irreducible, obstructed, strangulated; strangulation is a surgical emergency.

Trauma team activation: based on mechanism and physiology; clear leadership and role allocation; primary survey in first minutes.

Airway management: cervical spine immobilisation; rapid sequence induction with in-line stabilisation; surgical airway for failed intubation.

Breathing: high-flow oxygen, assess chest expansion, percussion, and auscultation; needle decompression for tension pneumothorax.

Circulation: control external haemorrhage with direct pressure or tourniquet; IV access with two large-bore cannulae; blood products for shock.

Disability: GCS, pupils, and limb movement; spinal precautions; early neurosurgical referral for deteriorating GCS.

Exposure: log-roll to examine back; prevent hypothermia with warm blankets and fluids.

Secondary survey: full examination and imaging; reassess frequently; document findings.

Definitive care: transfer to appropriate centre (major trauma, burns, neurosurgery); communicate with receiving team.

Postoperative hypotension: assess ABCDE; consider hypovolaemia, sepsis, MI, PE, and anaesthetic effects; check ECG, troponin, lactate, and bedside echo.

Postoperative hypoxia: common causes include atelectasis, pneumonia, PE, and opioid effect; give oxygen, sit up, and investigate.

Oliguria: check catheter, fluid status, and bladder scan; distinguish prerenal, renal, and postrenal causes.

Bleeding: monitor drain output, Hb, and vital signs; re-exploration if unstable; correct coagulopathy.

Sepsis: sepsis six within 1 hour; cultures, antibiotics, fluids, lactate, urine output, oxygen.

AKI: KDIGO staging; avoid nephrotoxins; fluid resuscitation; nephrology input for severe cases.

Delirium: 4AT or CAM; treat underlying cause; avoid restraint; involve family.

Discharge planning: criteria for safe discharge; written instructions; follow-up.

Haemostasis: primary (platelet plug) and secondary (coagulation cascade); tests include PT/INR, APTT, platelet count, and fibrinogen.

Coagulopathy in trauma: lethal triad (hypothermia, acidosis, coagulopathy); treat with blood products, warming, and correction of acidosis.

Anticoagulation reversal: warfarin with vitamin K and prothrombin complex; DOACs with specific reversal agents or PCC; heparin with protamine.

Thrombophilia: consider in recurrent VTE; test for factor V Leiden, protein C/S deficiency, antiphospholipid syndrome.

Blood products: PRBC, FFP, platelets, cryoprecipitate; indications and storage; check compatibility.

Transfusion reactions: acute haemolytic, febrile non-haemolytic, allergic, TRALI, TACO; stop transfusion and investigate.

Surgical nutrition: assess with MUST or NRS-2002; enteral feeding preferred; monitor refeeding syndrome.

Enhanced recovery: multimodal approach; reduce length of stay and complications.

Breast: triple assessment; fibroadenoma vs cancer; mastitis and abscess; gynaecomastia; nipple discharge.

Thyroid: nodule assessment; FNA; thyroid cancer types; hyperthyroidism surgery.

Parathyroid: primary hyperparathyroidism; raised calcium and PTH; sestamibi scan; parathyroidectomy.

Adrenal: incidentaloma; phaeochromocytoma (paroxysmal hypertension); adrenalectomy.

GI: dysphagia, reflux, gastric cancer, GIST; endoscopy and staging.

Colorectal: screening, polyps, cancer staging; rectal cancer neoadjuvant therapy.

Hepatobiliary: gallstones, pancreatitis, liver tumours; ERCP and surgery.

Vascular: PAD, AAA, carotid disease; duplex and CT angiography.

Acute limb ischaemia: 6 Ps; heparin; urgent vascular referral; embolectomy or bypass.

Necrotising fasciitis: severe pain, systemic upset, crepitus; urgent debridement; antibiotics; high mortality.

Fournier gangrene: necrotising fasciitis of perineum; urgent debridement; broad-spectrum antibiotics.

Gas gangrene: clostridial infection; crepitus, toxaemia; debridement and antibiotics; hyperbaric oxygen adjunct.

Abdominal compartment syndrome: raised intra-abdominal pressure >20 mmHg with organ dysfunction; decompressive laparotomy.

Bowel ischaemia: pain out of proportion; CT angiography; revascularisation or resection.

Perforated viscus: free air; resuscitate; laparotomy.

Major haemorrhage: activate protocol; tranexamic acid; blood products.

Preoperative assessment: history, examination, investigations; risk stratification; optimisation.

Consent: capacity, disclosure, voluntariness; document.

VTE prophylaxis: risk assessment; LMWH and mechanical; timing.

Antibiotic prophylaxis: within 60 minutes of incision; repeat as needed.

Fluid management: balanced crystalloids; avoid overload; monitor urine output.

Postoperative monitoring: vital signs, pain, urine output, wound; early warning scores.

Complications: bleeding, infection, VTE, AKI, delirium; early recognition and management.

Discharge: criteria; follow-up; documentation.

Surgical anatomy: important structures at risk in common operations (e.g., recurrent laryngeal nerve in thyroidectomy, common bile duct in cholecystectomy).

Surgical approach: incisions and their complications; laparoscopic vs open.

Haemostasis: diathermy, ligation, clips; check for bleeding before closure.

Wound closure: layers; suture choice; drains.

Postoperative care: analgesia, mobilisation, wound care.

Complications: early vs late; prevention and management.

Audit: morbidity and mortality; quality improvement.

Ethics: consent, capacity, confidentiality.

Upper GI: dyspepsia, ulcer, cancer; endoscopy.

Lower GI: change in bowel habit, bleeding; colonoscopy.

Hepatobiliary: jaundice, gallstones, pancreatitis; imaging.

Urology: haematuria, retention, stones; imaging.

Vascular: claudication, rest pain, ulcer; ABPI.

Breast: lump, discharge, pain; triple assessment.

Endocrine: thyroid, parathyroid, adrenal; biochemistry.

Trauma: primary and secondary survey; imaging.

Trauma: ATLS; primary survey; resuscitation.

Haemorrhage: control; blood products; tranexamic acid.

Head injury: GCS; CT; neurosurgical referral.

Chest trauma: tension pneumothorax; haemothorax; tamponade.

Abdominal trauma: FAST; CT; laparotomy.

Pelvic fracture: binder; angioembolisation.

Burns: Parkland; airway; fluids.

Damage control: abbreviated surgery; ICU.

Sepsis: sepsis six; antibiotics within 1 hour; fluids.

AKI: KDIGO; fluid; avoid nephrotoxins.

ARDS: lung-protective ventilation.

Delirium: 4AT; treat cause.

VTE: prophylaxis; treatment.

Glycaemic control: target 6-10 mmol/L.

Nutrition: enteral preferred.

Rehabilitation: early mobilisation.

Wound healing: phases; factors affecting.

Sutures: types; choice.

Diathermy: safety.

Sterile technique: scrubbing; gowning.

Drains: types; removal.

Antibiotics: prophylaxis; stewardship.

Fluids: compartments; maintenance.

Consent: principles.

Acute abdomen: assessment; common causes.

Bowel obstruction: small vs large; management.

Cholecystitis: ultrasound; early surgery.

Appendicitis: Alvarado; imaging.

Pancreatitis: causes; severity; management.

Diverticulitis: CT; antibiotics.

Ischaemic colitis: CT angiography.

Hernia: complications; surgery.

Acute limb ischaemia: 6 Ps; heparin; revascularisation.

Necrotising fasciitis: urgent debridement.

Fournier gangrene: debridement; antibiotics.

Abdominal compartment syndrome: decompression.

Bowel ischaemia: CT angiography; surgery.

Perforated viscus: free air; laparotomy.

Major haemorrhage: protocol; blood products.

Triage: mass casualty.

Postoperative fever: causes; investigation.

Hypotension: causes; assessment.

Hypoxia: causes; management.

Oliguria: causes; management.

Bleeding: recognition; management.

Sepsis: sepsis six.

AKI: KDIGO.

Delirium: 4AT.