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Iraqi Board General Surgery study materials
Iraqi Board General Surgery study resources

Iraqi Board General Surgery: Neurosurgery and Thoracic Surgery

Iraqi Board General Surgery · Work through your exam, one topic at a time.

All guide sections

Neurosurgery and Thoracic Surgery

Neurosurgery and Thoracic Surgery are tested at the level of recognition, initial management and safe referral, plus the emergencies that cannot wait for a specialist.

Head injury

  • GCS: eye 1-4, verbal 1-5, motor 1-6. Severe 8 or less, moderate 9-12, mild 13-15. A GCS of 8 or less needs intubation and CT.
  • Extradural haematoma: temporal blow, lucid interval, biconvex hyperdensity, middle meningeal artery - craniotomy is curative.
  • Subdural haematoma: bridging veins, crescentic, elderly or anticoagulated patients, gradual decline.
  • Subarachnoid haemorrhage: thunderclap headache; CT within 6 hours is highly sensitive, and if CT is negative with persisting suspicion beyond 12 hours, perform lumbar puncture for xanthochromia.
  • Raised ICP: head up 30 degrees, avoid hypoxia and hypotension, osmotherapy with mannitol or hypertonic saline, hyperventilation only as a bridge to theatre.

Spine

Cauda equina syndrome: bilateral sciatica, saddle anaesthesia, urinary retention, reduced anal tone - emergency MRI and decompression. ASIA grading for cord injury; high-dose steroids are not routine.

Thoracic

  • Spontaneous pneumothorax: primary in tall thin young men, secondary in COPD. Aspirate small stable collections; otherwise insert a drain in the safe triangle (4th-5th intercostal space, mid-axillary line).
  • Flail chest: the underlying pulmonary contusion causes the hypoxia, so analgesia and ventilatory support matter more than fixation.
  • Empyema: pleural fluid pH below 7.2, glucose below 2.2 mmol/L or positive Gram stain means drainage plus antibiotics.
  • Lung cancer: stage with CT and PET-CT; lobectomy with nodal dissection for stage I-II non-small-cell disease; small-cell disease is chemotherapy-led.

Worked example

A 24-year-old recovers briefly after a temporal blow, then deteriorates with a dilated left pupil and GCS 7. Extradural haematoma is the working diagnosis: intubate, brief hyperventilation, mannitol, then CT and craniotomy.

Traps

Lumbar puncture with raised ICP or focal signs; calling a lucid interval concussion; inserting a drain anteriorly in the 2nd intercostal space in adults.