Iraqi Board General Surgery common mistakes
Iraqi Board General Surgery · Understand the traps and how to avoid them.
Choosing an answer based on the single most familiar keyword in the stem (for example picking 'cholecystectomy' for any right upper quadrant pain) without first committing to the full clinical picture of history, examination, and initial investigation.
Candidates under time pressure pattern-match to a memorised association rather than reading the whole vignette; the exam deliberately includes two plausible options to punish this shortcut.
What to do instead
Before looking at the options, write a one-line problem representation (age, sex, key symptom, duration, key sign, one abnormal value). Then eliminate options that do not fit any element of that line. Practise with timed 30-question blocks and record every keyword-triggered error in an error log.
Managing shock with a single fluid bolus and then moving straight to surgery, without reassessing perfusion (mental status, capillary refill, urine output, lactate, base deficit) or considering blood products and damage-control principles.
Textbook algorithms are memorised as fixed sequences rather than as loops with reassessment; candidates also under-weight the lethal triad of hypothermia, acidosis, and coagulopathy.
What to do instead
Learn resuscitation as an assess-act-reassess cycle and state the reassessment endpoint in every answer. Drill ATLS-style scenarios aloud, naming the class of haemorrhage, the ratio-based transfusion strategy, and the trigger for definitive or damage-control surgery.
Describing an operation or diagnosis in general terms ('explore the abdomen', 'give antibiotics') instead of specifying the incision, the structure to be divided or preserved, the antibiotic class and timing, or the threshold for reoperation.
Undergraduate-level summaries feel sufficient, but the exam rewards operative and perioperative specificity; vague options are usually the distractors.
What to do instead
Build one-page operative cards for each core procedure listing indication, incision, key steps, structures at risk, drain policy, and postoperative milestones. For every antibiotic answer, state agent, dose timing relative to incision, and duration.
Ignoring the anatomical relations of a structure when predicting the complication of an operation, for example failing to link common bile duct injury to the triangle of Calot, or recurrent laryngeal nerve injury to the course of the nerve relative to the inferior thyroid artery.
Anatomy is studied separately from surgery, so candidates cannot translate a structure into its operative hazard; the exam tests exactly this translation.
What to do instead
Study anatomy through operative hazard maps: for each named operation, draw the operative field and label the three structures most at risk and the manoeuvre that protects each. Review with a cadaveric or operative atlas rather than a pure anatomy text.
Staging and oncological planning errors: confusing T, N, and M definitions, missing the difference between clinical and pathological staging, or recommending resection without stating margin and lymphadenectomy principles and the indication for neoadjuvant therapy.
Staging systems are memorised as tables without being tied to treatment decisions, and candidates rarely practise converting a stage into a management plan.
What to do instead
For each major tumour (breast, colorectal, gastric, oesophageal, thyroid, pancreatic), write the stage-to-treatment algorithm yourself, including which stages get neoadjuvant therapy, the minimum lymph node yield, and what a positive margin means. Test yourself by generating a stage and defending the plan.
Applying adult thresholds and doses to paediatric surgical scenarios, such as using adult fluid bolus volumes, adult analgesic doses, or adult criteria for intussusception, pyloric stenosis, or testicular torsion.
Paediatric surgery is revised last and treated as a minor variant of adult surgery; weight-based calculations and age-specific presentations are then recalled imprecisely.
What to do instead
Keep a paediatric card with weight-based fluid boluses, maintenance fluid rules, analgesia doses, and the classic age window and presentation of each congenital and acquired condition. Rehearse calculations with sample weights until they are automatic.
Treating the burn or trauma patient as a single-organ problem: estimating burn surface area inaccurately, forgetting inhalation injury and escharotomy indications, or missing associated injuries in a patient with an obvious distracting injury.
Attention is captured by the dramatic visible wound, and candidates do not systematically run a secondary survey or a burn-specific checklist.
What to do instead
Use a fixed checklist for every burn or trauma stem: airway and inhalation signs, surface area estimate by a named method, fluid formula with time zero, escharotomy and compartment indications, tetanus and analgesia, and associated injury screen. Practise on ten vignettes until the checklist is automatic.
Confusing wound healing and infection timelines: misclassifying a wound as infected versus seroma or dehiscence, choosing the wrong time window for primary versus delayed primary closure, or misjudging when a mesh or graft can safely be placed in a contaminated field.
Wound care is treated as common sense rather than as a set of timed biological phases and contamination classes, so answers default to 'antibiotics and dressings'.
What to do instead
Learn the four healing phases with their day ranges and the surgical wound classification with expected infection risk. For each class, state the closure strategy and implant policy. Apply this to short case stems until classification is immediate.
Vascular and limb ischaemia errors: missing the difference between acute and chronic limb ischaemia, failing to state the urgency of revascularisation, or omitting compartment pressure monitoring and anticoagulation after embolectomy or bypass.
Vascular surgery is a small part of most curricula, so candidates rely on vague recall of 'urgent referral' and cannot rank options by time-criticality.
What to do instead
Build a table of acute versus chronic limb ischaemia with the six P signs, Rutherford or Fontaine categories, imaging choice, and the revascularisation window. Add post-revascularisation monitoring, including compartment syndrome and anticoagulation, to every answer.
Answering ethics, professionalism, and evidence-based surgery items with personal opinion or hierarchy ('the consultant decides') rather than with the stated principles of consent, capacity, confidentiality, disclosure of harm, and the levels of evidence.
These topics are assumed to be intuitive and are not revised, yet the exam uses them to test whether candidates can apply a framework under pressure.
What to do instead
Memorise the four ethical principles and the consent and capacity criteria, and practise applying them to short scenarios about a Jehovah's Witness patient, a minor, an impaired colleague, or a surgical error. Separately learn to rank study designs and to interpret confidence intervals, number needed to treat, and sensitivity and specificity.