OMSB General Surgery (OEGS) cheat sheet

ATLS primary survey sequence: catastrophic haemorrhage control, Airway with cervical spine protection, Breathing/ventilation, Circulation with haemorrhage control, Disability (GCS, pupils), Exposure with prevention of hypothermia; adjuncts include ECG, pulse oximetry, capnography, urinary and gastric catheters, and FAST.

Shock index (heart rate divided by systolic blood pressure) above 0.9 in trauma predicts need for massive transfusion; class III haemorrhage (30-40% loss) shows tachycardia, narrowed pulse pressure, hypotension, and confusion.

Acute appendicitis: Alvarado score components (migration of pain 1, anorexia 1, nausea/vomiting 1, right lower quadrant tenderness 2, rebound 1, fever 1, leukocytosis 2, left shift 1); score 7 or more supports operative management.

Acute cholecystitis is diagnosed by Tokyo Guidelines triad: local inflammation signs (Murphy sign, RUQ tenderness), systemic inflammation (fever, raised CRP/WCC), and imaging findings; early laparoscopic cholecystectomy within 72 hours is preferred in fit patients.

Sepsis: qSOFA uses respiratory rate 22/min or more, altered mentation, systolic BP 100 mmHg or less (score 2 or more = high risk); septic shock is defined as vasopressor requirement plus lactate above 2 mmol/L despite adequate fluid resuscitation.

Bowel obstruction: supine and erect abdominal films show dilated loops and air-fluid levels; CT is the modality of choice to identify transition point, closed-loop obstruction, strangulation, and free gas.

Hernia: indirect inguinal hernia is lateral to inferior epigastric vessels and enters the deep ring; direct hernia is medial through Hesselbach triangle; femoral hernia is below and lateral to the pubic tubercle and carries highest strangulation risk.

Thyroid surgery: recurrent laryngeal nerve injury causes hoarseness, external branch of superior laryngeal nerve injury causes voice fatigue/pitch loss, and bilateral RLN injury causes stridor requiring immediate re-intubation; hypocalcaemia from parathyroid devascularisation presents with perioral tingling and Chvostek/Trousseau signs.

Wound assessment uses the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) for trauma, while for surgical wounds the key rule is: any wound with devitalised tissue, contamination, or delayed presentation over 6 hours requires debridement and delayed primary closure rather than primary closure.

Breast: triple assessment comprises clinical examination, imaging (ultrasound under 40 years, mammography 40 years and over), and tissue sampling (core biopsy preferred over fine needle aspiration for solid lesions); triple-negative receptor status (ER, PR, HER2 all negative) carries the worst prognosis and requires systemic chemotherapy.

Colorectal cancer: right-sided tumours present with iron-deficiency anaemia and mass; left-sided with obstruction and altered bowel habit; rectal bleeding with change in bowel habit over 6 weeks in patients over 50 warrants urgent referral for colonoscopy.

Pancreatitis: Ranson criteria and modified Glasgow (Imrie) score predict severity at 48 hours; serum lipase is more sensitive and specific than amylase; necrotising pancreatitis with infected necrosis requires delayed (4 weeks) necrosectomy, not early open surgery.

Liver: Child-Pugh score (bilirubin, albumin, INR, ascites, encephalopathy) stratifies cirrhosis for surgery; MELD uses bilirubin, INR, creatinine; a Child C patient is generally unsuitable for major hepatic resection.

Upper GI bleeding: Glasgow-Blatchford score predicts need for intervention (score 0-1 may be discharged); Rockall score predicts rebleeding and mortality post-endoscopy; variceal bleeding is managed with terlipressin, prophylactic antibiotics, and band ligation.

Burns: Parkland formula for crystalloid = 4 mL x body weight (kg) x %TBSA burned, half in first 8 hours from time of burn; Rule of Nines: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.

Perioperative: VTE risk assessment (Caprini score) determines prophylaxis; WHO surgical safety checklist reduces morbidity and mortality; enhanced recovery after surgery (ERAS) principles include carbohydrate loading, opioid-sparing analgesia, early feeding, and early mobilisation.

Surgical audit cycle: define standards, collect data, compare against standard, implement change, re-audit; clinical governance in OMS B training requires documented reflective practice and morbidity/mortality meeting participation.

Trauma: FAST is sensitive for pericardial and free intraperitoneal fluid but not for retroperitoneal injury; unstable patient with positive FAST requires immediate laparotomy; stable patient with positive FAST can undergo CT angiography.

Damage control surgery triad: control haemorrhage and contamination, temporary abdominal closure, then ICU correction of hypothermia, acidosis, and coagulopathy before definitive repair.

Acute limb ischaemia: 6 Ps (pain, pallor, pulselessness, paraesthesia, paralysis, perishing cold); Rutherford classification guides urgency; immediate heparinisation and embolectomy or bypass; compartment syndrome risk after reperfusion.

Abdominal aortic aneurysm: repair indicated at diameter 5.5 cm in men or 5.0 cm in women, or rapid growth above 1 cm/year, or symptomatic; ruptured AAA presents with back pain, hypotension, and pulsatile mass.

Peripheral arterial disease: ABPI below 0.9 indicates disease; ABPI below 0.4 indicates critical limb-threatening ischaemia; falsely elevated ABPI in diabetes due to medial calcinosis (may exceed 1.3).

Colorectal anastomosis: right hemicolectomy for caecal/ascending colon; anterior resection for sigmoid/upper rectum; low anterior resection for mid/low rectum with total mesorectal excision; Hartmann procedure leaves an end colostomy for emergency left-sided obstruction.

Appendicitis in pregnancy: appendix displaced superiorly by gravid uterus; MRI is preferred imaging after ultrasound is inconclusive; laparoscopic appendectomy is safe in all trimesters.

Postoperative fever timing: within 48 hours consider atelectasis and early infection; days 3-5 consider urinary tract infection and pneumonia; days 5-7 consider surgical site infection and anastomotic leak; days 7-10 consider deep abscess; after 10 days consider VTE.

Fluid and electrolyte: maintenance needs approximately 25-30 mL/kg/day water, 1 mmol/kg/day sodium and potassium; 0.9% saline causes hyperchloraemic acidosis; balanced crystalloids (Hartmann/Ringer's lactate) preferred for resuscitation.

Nutrition: NICE criteria for parenteral nutrition include BMI under 18.5, unintentional weight loss above 10% in 3-6 months, or inadequate oral intake for more than 5 days; refeeding syndrome risk requires thiamine and slow caloric escalation.

Anastomotic leak signs: tachycardia, fever, ileus, peritonitis, rising CRP and lactate; CT with water-soluble contrast confirms; management ranges from antibiotics and drainage to re-laparotomy and diversion.

Surgical site infection: classified as superficial incisional, deep incisional, or organ/space; Staphylococcus aureus most common; prophylaxis is a single preoperative dose of appropriate antibiotic within 60 minutes of incision.

Acute mesenteric ischaemia: pain out of proportion to examination; raised lactate and D-dimer are nonspecific; CT angiography is diagnostic; SMA embolism often follows atrial fibrillation.

Gallstone ileus: Rigler triad on CT (pneumobilia, small bowel obstruction, ectopic gallstone); treatment is enterolithotomy, with cholecystectomy reserved for fit patients.

Bariatric surgery: NICE eligibility is BMI 40 or more, or 35 or more with comorbidity, or 30 or more with recent-onset type 2 diabetes; sleeve gastrectomy and Roux-en-Y gastric bypass are most common; thiamine and B12 supplementation required.

Head injury with anticoagulation: any head injury on warfarin or DOAC requires CT within 8 hours and consideration of reversal; GCS drop of 2 or more points mandates urgent repeat imaging.

Hepatobiliary: Mirizzi syndrome (common hepatic duct compression by impacted stone in Hartmann pouch) causes obstructive jaundice; ERCP is first-line for choledocholithiasis; laparoscopic cholecystectomy is definitive.

Bile duct injury during cholecystectomy is classified by Strasberg (A-E); major injuries (E) require referral to a specialist hepatobiliary unit and Roux-en-Y hepaticojejunostomy, not primary repair.

Urology in general surgery: acute urinary retention requires catheterisation; haematuria in patients over 45 warrants cystoscopy; testicular torsion is a surgical emergency with bell-clapper deformity and requires bilateral orchidopexy.

Colorectal polyps: adenomas follow the adenoma-carcinoma sequence; villous adenomas and those over 2 cm carry higher malignant potential; post-polypectomy surveillance depends on number, size, and histology.

Breast: sentinel lymph node biopsy uses blue dye and/or radioisotope; axillary dissection indicated for 2 or more positive nodes; neoadjuvant chemotherapy may downstage locally advanced disease.

Thyroid cancer: papillary (most common, lymphatic spread, excellent prognosis), follicular (haematogenous spread), medullary (calcitonin marker, MEN2 association), anaplastic (rapid, poor prognosis); total thyroidectomy and radioiodine for differentiated cancers above 1 cm.

Paediatric surgery: intussusception presents with colicky pain, redcurrant jelly stool, and sausage-shaped mass; air or contrast enema is both diagnostic and therapeutic; hypertrophic pyloric stenosis presents at 3-6 weeks with projectile non-bilious vomiting and hypochloraemic hypokalaemic metabolic alkalosis.

Trauma in pregnancy: resuscitate the mother first; left lateral tilt 15-30 degrees after 20 weeks to relieve inferior vena cava compression; Kleihauer-Betke test for fetomaternal haemorrhage and anti-D if Rh-negative.

Rectal bleeding: painless fresh bleeding in older adults suggests colorectal cancer until excluded; painful bleeding with a fissure suggests benign disease; rigid sigmoidoscopy is insufficient to exclude proximal lesions.

Anal fissure: posterior midline most common; first-line is stool softeners, fibre, and topical GTN or diltiazem; chronic fissure with sentinel pile requires lateral internal sphincterotomy or botulinum toxin.

Haemorrhoids: grade I (bleeding only), II (prolapse reduces spontaneously), III (manual reduction), IV (irreducible); rubber band ligation for grade II-III, surgery for grade IV; exclude malignancy before treating.

Perianal abscess requires prompt incision and drainage; fistula-in-ano classified by Parks (intersphincteric, transsphincteric, suprasphincteric, extrasphincteric); EUA with fistula probe is standard assessment.

Pilonidal sinus: acute abscess needs incision and drainage; chronic disease managed with excision and primary closure or flap; risk factors include hairy body habitus and prolonged sitting.

Breast abscess: lactational abscess requires ultrasound-guided aspiration or incision and drainage; continue breastfeeding; mastitis without abscess is treated with antibiotics and drainage of milk.

Thyroid nodule: fine needle aspiration cytology reported by Bethesda system; Bethesda 4-6 warrant surgery; Bethesda 1-3 require repeat or ultrasound surveillance.

Surgical informed consent: must include material risks a reasonable patient would consider significant, alternatives, and consequences of no treatment; documented capacity assessment and best-interests decision for patients lacking capacity.

Abdominal compartment syndrome: intra-abdominal pressure above 20 mmHg with new organ dysfunction; measured via bladder catheter; treatment includes decompression, neuromuscular blockade, paracentesis, and decompressive laparotomy with temporary closure.

Acute pancreatitis severity: Atlanta classification distinguishes mild, moderately severe (local complications or organ failure under 48 hours), and severe (persistent organ failure above 48 hours); early enteral feeding is preferred to parenteral.

Postoperative ileus versus obstruction: ileus is generalised, painless, and self-limiting over 3-5 days; obstruction is colicky with vomiting and absolute constipation; CT distinguishes mechanical from paralytic.

Enterocutaneous fistula: SNAP principles (Sepsis control, Nutrition, Anatomy definition, Procedure); high-output fistula above 500 mL/day requires fluid and electrolyte replacement and parenteral nutrition.

Splenectomy: encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) risk overwhelming post-splenectomy sepsis; vaccinations 2 weeks preoperatively or on discharge, plus lifelong penicillin prophylaxis and alert card.

Adrenal incidentaloma: assess for hormonal excess (cortisol, aldosterone, metanephrines) and size; lesions above 4 cm or with suspicious imaging features warrant resection.

Colorectal emergency: obstructing left colon may be managed with stent as bridge to surgery; perforated diverticulitis (Hinchey III/IV) requires resection with or without primary anastomosis; Hinchey I-II may respond to antibiotics and drainage.

Perioperative diabetes: target blood glucose 6-10 mmol/L; hold metformin if contrast or renal impairment; variable-rate intravenous insulin infusion for major surgery; avoid hypoglycaemia which carries higher immediate risk than mild hyperglycaemia.

Gastric cancer: intestinal type follows Correa cascade (H. pylori, atrophic gastritis, intestinal metaplasia, dysplasia); diffuse type (signet ring) has worse prognosis and is associated with CDH1 mutation; D2 lymphadenectomy for resectable disease.

Oesophageal cancer: adenocarcinoma arises in Barrett oesophagus in distal oesophagus; squamous cell carcinoma arises in mid/upper oesophagus and is associated with smoking and alcohol; staging with CT, PET-CT, and endoscopic ultrasound.

Gastro-oesophageal reflux: alarm features (dysphagia, weight loss, anaemia, age over 55 with new symptoms) mandate endoscopy; Nissen fundoplication for refractory disease with proven acid exposure.

Peptic ulcer disease: H. pylori eradication reduces recurrence; perforated duodenal ulcer managed with omental patch (Graham) and peritoneal lavage; bleeding ulcer managed with endoscopic clips/adrenaline and high-dose proton pump inhibitor.

Hernia repair: Lichtenstein tension-free mesh repair is standard for inguinal hernia; laparoscopic (TEP/TAPP) preferred for bilateral or recurrent hernia; strangulated hernia requires emergency surgery with bowel viability assessment.

Wound healing: primary intention for clean approximated wounds; secondary intention for contaminated or open wounds; tertiary (delayed primary) closure after debridement; factors impairing healing include diabetes, steroids, malnutrition, smoking, and radiotherapy.

Surgical oncology margins: R0 (microscopically clear), R1 (microscopic involvement), R2 (macroscopic residual); margin clearance varies by tumour type (e.g., 1 mm for breast, 1 cm for melanoma, circumferential resection margin for rectal cancer).

Acute scrotum: Doppler ultrasound distinguishes torsion from epididymo-orchitis; torsion requires exploration within 6 hours for testicular salvage; bilateral fixation prevents recurrence.

Antibiotic prophylaxis: single dose within 60 minutes before incision; re-dose for prolonged surgery above 3 hours or major blood loss; clean surgery without implant generally does not require prophylaxis.

Local anaesthetic maximum doses: lidocaine 3 mg/kg plain or 7 mg/kg with adrenaline; bupivacaine 2 mg/kg; calculate cumulative dose including tumescent infiltration to avoid LAST (local anaesthetic systemic toxicity), treated with lipid emulsion.

Diathermy safety: avoid in patients with pacemakers or implanted defibrillators (use bipolar or cardiology input); never use in bowel with high oxygen concentration; return electrode close to operative site.

Suture materials: absorbable (vicryl, monocryl, PDS) versus non-absorbable (prolene, nylon, silk); monofilament preferred in contaminated fields; polydioxanone retains strength longest among absorbable.

Drains and tubes: Robinson drain for dependent fluid; nasogastric tube for decompression; pigtail catheter for collections; remove drains when output is low and no leak suspected.

Stoma care: ileostomy output high in sodium and water, risk of dehydration and hypomagnesaemia; colostomy more formed; loop ileostomy often reversed after 8-12 weeks following low anterior resection.

Surgical site classification: clean, clean-contaminated, contaminated, dirty; infection rates rise with wound class; prophylactic antibiotics indicated for clean-contaminated and contaminated wounds.

Trauma radiology: CT is gold standard for stable trauma patients; FAST for unstable; pelvic X-ray for suspected pelvic fracture; CT cystography for suspected bladder injury.

Thyroidectomy complications: haematoma causing airway compromise requires immediate opening of the wound at bedside; hypocalcaemia peaks at 24-72 hours; RLN injury may be transient or permanent.

Parathyroid disease: primary hyperparathyroidism most commonly due to single adenoma; indications for surgery include calcium above 0.25 mmol/L above upper limit, renal stones, reduced bone density, and age under 50; sestamibi scan and intraoperative PTH monitoring.

Adrenal surgery: phaeochromocytoma requires alpha blockade (phenoxybenzamine) 10-14 days preoperatively followed by beta blockade; avoid beta blockade first due to unopposed alpha vasoconstriction.

Breast cancer staging: TNM; sentinel node biopsy for clinically node-negative disease; axillary dissection for node-positive; staging scans for stage III or symptomatic stage IV.

Colorectal liver metastases: resectable disease has 5-year survival up to 50%; neoadjuvant chemotherapy may downstage; two-stage hepatectomy for bilateral disease; ablation for unresectable small lesions.

Surgical training in OMS B: competence-based progression with WBAs (DOPS, mini-CEX, CBD), logbook of operations, and annual review of competence progression (ARCP); research and audit are mandatory components.

Ethics and law: valid consent requires capacity, adequate information, and voluntariness; in emergencies treatment may proceed under necessity; advance decisions to refuse treatment must be respected if valid and applicable.

Communication: breaking bad news uses SPIKES framework (Setting, Perception, Invitation, Knowledge, Emotions, Strategy); documentation must be contemporaneous, legible, signed, and include date and time.

Abdominal pain in the elderly: presentation may be atypical with absence of fever or leukocytosis; lower threshold for CT and surgical review; higher mortality in perforation and ischaemia.

Acute diverticulitis: Hinchey classification (I pericolic abscess, II pelvic abscess, III purulent peritonitis, IV faecal peritonitis); CT is diagnostic; outpatient management for uncomplicated disease; antibiotics for complicated disease.

Appendiceal mass: if phlegmon or abscess, manage with antibiotics and drainage, with interval appendectomy considered at 6-8 weeks; avoid immediate surgery unless peritonitis.

Gallstone pancreatitis: urgent ERCP within 72 hours if cholangitis or persistent obstruction; cholecystectomy during same admission for mild gallstone pancreatitis.

Bowel ischaemia: superior mesenteric artery embolism often at middle colic branch; venous thrombosis presents with less severe pain and better prognosis; anticoagulation for venous mesenteric thrombosis.

Trauma haemorrhage control: massive transfusion protocol with balanced ratio (1:1:1 red cells, plasma, platelets); tranexamic acid within 3 hours of injury; permissive hypotension until haemorrhage controlled.

Surgical nutrition: enteral nutrition within 24-48 hours of major surgery reduces infection and length of stay; immunonutrition (arginine, omega-3) considered in malnourished cancer patients.

Quality improvement: morbidity and mortality meetings, root cause analysis, and the WHO checklist are core patient safety tools; incident reporting is mandatory and non-punitive.

Acute abdomen in women of childbearing age: pregnancy test mandatory; consider ectopic pregnancy, ovarian torsion, and pelvic inflammatory disease alongside appendicitis; laparoscopy is both diagnostic and therapeutic.

Ovarian torsion: sudden severe unilateral pain with nausea and vomiting; Doppler may be normal in early torsion; detorsion with ovarian preservation is preferred over oophorectomy.

Endometriosis: can mimic malignancy with cyclical pain and pelvic mass; diagnosis is laparoscopic; surgical excision for symptomatic disease.

Gynaecological malignancy: postmenopausal bleeding requires endometrial biopsy; CA-125 is not a screening test but useful for monitoring; BRCA mutation carriers consider risk-reducing surgery.

Urological emergencies: Fournier gangrene requires urgent debridement and broad-spectrum antibiotics; obstructed infected kidney requires urgent decompression with nephrostomy or stent.

Renal colic: CT KUB is gold standard; NSAIDs first-line analgesia; stones under 5 mm usually pass spontaneously; ureteroscopy for stones above 10 mm or failed conservative management.

Testicular cancer: painless lump; alpha-fetoprotein and beta-hCG tumour markers; inguinal orchidectomy with staging CT; chemotherapy for metastatic disease.

Prostate: acute retention with painful bladder requires catheterisation; benign prostatic hyperplasia managed with alpha blockers and 5-alpha reductase inhibitors; PSA above 4 ng/mL warrants urology referral.

Paediatric appendicitis: presentation may be atypical with vomiting and peritonism; ultrasound first-line; laparoscopic appendectomy standard; consider mesenteric adenitis and intussusception in differential.

Neonatal surgical emergencies: bilious vomiting in a neonate indicates malrotation with volvulus until excluded; contrast study and urgent laparotomy; duodenal atresia shows double-bubble sign.

Hirschsprung disease: delayed passage of meconium, abdominal distension, and enterocolitis risk; diagnosis by rectal biopsy showing aganglionosis; pull-through procedure.

Undescended testis: orchidopexy by 12-18 months to reduce malignancy and infertility risk; impalpable testis requires laparoscopy.

Inguinal hernia in infants: higher risk of incarceration; early repair recommended; distinguish from hydrocele by transillumination and reducibility.

Trauma in children: pectus and rib fractures suggest significant force; FAST less reliable in children; CT used judiciously due to radiation sensitivity.

Burns in children: higher body surface area to weight ratio; Parkland formula still applies; consider non-accidental injury if pattern inconsistent with history.

Neonatal jaundice and biliary atresia: persistent conjugated hyperbilirubinaemia requires urgent investigation; Kasai portoenterostomy before 60 days improves outcomes.

Breast screening: mammography every 2 years for women aged 50-70 (extended to 47-73 in some programmes); high-risk women (BRCA) require MRI surveillance.

Breast cancer subtypes: luminal A (ER/PR positive, HER2 negative, low Ki-67) best prognosis; luminal B higher proliferation; HER2-enriched treated with trastuzumab; triple-negative treated with chemotherapy and immunotherapy.

Breast surgery: breast-conserving surgery plus radiotherapy equivalent to mastectomy for early-stage disease; mastectomy with reconstruction offered for multicentric disease or patient preference.

Sentinel node: radioisotope and blue dye; if positive, axillary clearance or axillary radiotherapy depending on findings; micrometastases may not require clearance.

Male breast cancer: rare, often ER positive; associated with BRCA2 and Klinefelter syndrome; treated similarly to female breast cancer.

Breast infection: lactational mastitis treated with antibiotics and continued drainage; recurrent abscess may require biopsy to exclude inflammatory cancer.

Gynaecomastia: physiological in puberty and ageing; drug-induced (spironolactone, cimetidine, digoxin); surgery for persistent symptomatic cases.

Phyllodes tumour: fibroepithelial lesion with leaf-like architecture; wide local excision with clear margins; malignant variants may metastasise haematogenously.

Colorectal screening: faecal immunochemical test (FIT) for average-risk adults; colonoscopy for positive FIT; surveillance intervals based on polyp findings.

Colorectal cancer staging: TNM and Dukes; T1-T2 N0 M0 stage I; T3-T4 or N1 stage II-III; M1 stage IV; adjuvant chemotherapy for stage III and high-risk stage II.

Rectal cancer: neoadjuvant chemoradiotherapy for locally advanced (T3/T4 or node-positive); total mesorectal excision; watch-and-wait for complete clinical response in selected patients.

Anal cancer: squamous cell carcinoma associated with HPV; chemoradiotherapy (mitomycin and 5-fluorouracil) is first-line; surgery reserved for salvage.

Colonic polyps: sessile serrated lesions have malignant potential via BRAF pathway; complete excision with clear margins required; surveillance based on size and histology.

Inflammatory bowel disease surgery: ulcerative colitis curative with proctocolectomy and ileal pouch-anal anastomosis; Crohn disease surgery for complications, not curative; stricturoplasty preserves bowel length.

Familial adenomatous polyposis: APC mutation; prophylactic colectomy recommended; screening from adolescence; risk of duodenal and thyroid cancer.

Lynch syndrome: mismatch repair gene mutation; colorectal and endometrial cancer risk; aspirin chemoprophylaxis and intensive surveillance.

Hepatocellular carcinoma: surveillance with ultrasound every 6 months in cirrhosis; diagnosis by multiphasic CT/MRI showing arterial enhancement and washout; resection, ablation, or transplant depending on liver function.

Liver trauma: non-operative management for haemodynamically stable patients; angioembolisation for active bleeding; laparotomy for instability or peritonitis.

Biliary colic versus cholecystitis: colic is self-limiting RUQ pain after fatty food; cholecystitis has persistent pain, fever, and positive Murphy sign; cholecystectomy for both, timing differs.

Choledocholithiasis: MRCP or EUS to confirm; ERCP with sphincterotomy and stone extraction; laparoscopic bile duct exploration if ERCP unavailable.

Pancreatic cancer: painless jaundice, weight loss, new-onset diabetes; CT pancreas protocol for staging; Whipple procedure for resectable head tumours; palliative bypass or stent for unresectable.

Pancreatic pseudocyst: develops after 4 weeks; symptomatic or enlarging cysts require drainage (endoscopic or surgical); avoid drainage before wall maturation.

Splenic trauma: non-operative management for stable patients; splenectomy for haemodynamic instability; post-splenectomy vaccination and prophylaxis.

Adrenal mass: assess function and size; pheochromocytoma requires biochemical screening with metanephrines before any intervention to avoid hypertensive crisis.

Shock types: hypovolaemic (haemorrhage, dehydration), cardiogenic (MI, arrhythmia), distributive (sepsis, anaphylaxis), obstructive (tamponade, tension pneumothorax, massive PE); management differs by cause.

Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) into anterolateral thigh, repeat after 5 minutes; remove trigger; airway support; antihistamines and steroids are adjuncts only.

Tension pneumothorax: clinical diagnosis; immediate needle decompression in second intercostal space midclavicular line or fifth intercostal space anterior axillary line, followed by chest drain.

Cardiac tamponade: Beck triad (hypotension, distended neck veins, muffled heart sounds); pulsus paradoxus; pericardiocentesis under ultrasound guidance.

Massive haemorrhage: activate protocol, warm fluids, tranexamic acid, calcium replacement, avoid crystalloid overload; monitor for hypothermia, acidosis, and coagulopathy.

Sepsis bundle: cultures before antibiotics, broad-spectrum antibiotics within 1 hour, 30 mL/kg crystalloid for hypotension or lactate above 4 mmol/L, vasopressors for MAP below 65 mmHg.

Acute respiratory distress: postoperative hypoxia may be atelectasis, aspiration, pulmonary embolism, or pneumonia; CT pulmonary angiography for suspected PE; chest X-ray first for most.

Perioperative cardiac risk: revised cardiac risk index (RCRI) predicts major adverse cardiac events; functional capacity assessment; cardiology input for unstable symptoms before elective surgery.

Wound infection prevention: chlorhexidine skin preparation, hair removal with clippers not razor, normothermia, glycaemic control, and supplemental oxygen during surgery.

Surgical hand scrub: chlorhexidine or povidone-iodine; alcohol-based rubs require dry hands; jewellery removed; nails short and no artificial nails.

Sterile field: gown and gloves; maintain sterile field above waist; contaminated instruments separated; change gloves after contamination.

Sharps safety: never recap needles by hand; use sharps container at point of use; report needlestick injuries immediately and follow local PEP protocol.

Personal protective equipment: gloves, gown, mask, eye protection for exposure-prone procedures; double gloving for high-risk orthopaedic or major surgery.

Diathermy: use lowest effective power; avoid in patients with implanted devices; smoke evacuation to reduce surgical smoke exposure.

Patient positioning: pressure area protection, nerve padding, avoid hyperextension; document positioning and skin integrity.

Surgical counts: swab, needle, and instrument counts at start and before closure; radiograph if count discrepancy; document in operation note.

Trauma secondary survey: head-to-toe examination with log roll, perineal and rectal examination; reassess ABCs regularly; document GCS, pupils, and limb neurology.

Head injury: GCS 13-15 mild, 9-12 moderate, 3-8 severe; CT within 1 hour for GCS below 13, focal deficit, seizure, or anticoagulation; neurosurgical referral for deteriorating GCS or mass effect.

Spinal injury: immobilise until cleared; Canadian C-spine rule and NEXUS criteria guide imaging; log roll for transfer; high-dose steroids not recommended routinely.

Chest trauma: rib fractures, flail chest, haemothorax, pneumothorax, cardiac contusion; analgesia and physiotherapy for rib fractures; chest drain for haemothorax or pneumothorax.

Abdominal trauma: blunt versus penetrating; laparotomy for haemodynamic instability, peritonitis, evisceration, or free gas; selective non-operative management for solid organ injury in stable patients.

Pelvic fracture: high-energy mechanism; assess for haematuria and urethral injury; binder for haemodynamic instability; angioembolisation for arterial bleeding.

Limb trauma: assess pulses, sensation, and motor function; vascular injury requires urgent exploration or angiography; compartment syndrome needs fasciotomy.

Burns: assess airway for inhalation injury (singed nares, soot, hoarseness); escharotomy for circumferential burns; fluid resuscitation and analgesia; refer to burns unit for major burns.

Perioperative medication: continue beta-blockers, statins, and most antihypertensives; stop clopidogrel 5-7 days before elective surgery unless high thrombotic risk; bridge anticoagulation with heparin for mechanical valves.

Anticoagulation reversal: warfarin with vitamin K and prothrombin complex concentrate; dabigatran with idarucizumab; other DOACs with andexanet alfa or prothrombin complex concentrate.

Blood transfusion: restrictive threshold (haemoglobin 7-8 g/dL) in most surgical patients; crossmatch for major surgery; check patient identity and blood product compatibility at bedside.

Transfusion reactions: febrile non-haemolytic most common; acute haemolytic reaction presents with fever, loin pain, and haemoglobinuria; stop transfusion immediately and investigate.

Perioperative steroids: patients on long-term steroids require supplemental hydrocortisone for major surgery to prevent adrenal crisis; taper postoperatively.

Perioperative insulin: variable-rate intravenous insulin infusion for major surgery; monitor glucose hourly; target 6-10 mmol/L.

Perioperative analgesia: multimodal with paracetamol, NSAIDs (caution renal), opioids, and regional blocks; opioid-sparing reduces ileus and length of stay.

Perioperative nausea and vomiting: risk factors include female sex, non-smoker, history of PONV, and opioid use; prophylaxis with ondansetron and dexamethasone.

Surgical documentation: operation note must include date, time, surgeons, procedure, findings, complications, specimens, counts, and postoperative instructions.

Consent: documented discussion of risks, benefits, alternatives, and consequences of no treatment; use of interpreters where needed; capacity assessment.

Confidentiality: patient information shared only on need-to-know basis; disclosure without consent only when required by law or public interest.

Duty of candour: disclose harm to patients openly and apologise; document the discussion; report to risk management.

Fitness to practise: maintain competence, engage in CPD, and declare conflicts of interest; GMC or equivalent standards apply.

Research ethics: informed consent, ethics committee approval, and data protection; vulnerable populations require additional safeguards.

Clinical governance: audit, incident reporting, and quality improvement projects; participation is a training requirement.

Teamwork: WHO surgical safety checklist (sign in, time out, sign out) reduces errors and improves communication.

Abdominal examination: inspection, palpation, percussion, auscultation; check for hernia orifices; digital rectal examination for rectal bleeding or suspected malignancy.

Acute abdominal pain: SOCRATES mnemonic; location and migration guide diagnosis; peritoneal signs indicate surgical emergency.

Hernia examination: inspect standing and lying; palpate with cough impulse; differentiate direct and indirect; check for strangulation and obstruction.

Breast examination: inspect with arms up and hands on hips; palpate quadrants; check axilla and supraclavicular fossa; nipple discharge character.

Thyroid examination: inspect with swallow, palpate from behind, assess for retrosternal extension; check for lymphadenopathy and vocal cord function.

Peripheral vascular examination: inspect for ulcers, palpate pulses, auscultate for bruits, measure ABPI; Buerger test for arterial insufficiency.

Digital rectal examination: assess sphincter tone, prostate size and nodules, rectal masses, and blood; use in colorectal and urological assessment.

Trauma examination: primary and secondary survey; log roll for spinal and back injuries; reassess after interventions.

Surgical oncology principles: en bloc resection with clear margins; avoid tumour spillage; sentinel node biopsy for staging; multidisciplinary team discussion for all cancer cases.

MDT meeting: core members include surgeon, oncologist, radiologist, pathologist, and specialist nurse; decisions documented and communicated to patient.

Neoadjuvant therapy: downstages locally advanced tumours; used in rectal, oesophageal, and breast cancer; response assessed on imaging and pathology.

Adjuvant therapy: after resection to reduce recurrence; chemotherapy for stage III colorectal and high-risk breast; radiotherapy for breast-conserving surgery and rectal cancer.

Tumour markers: CEA for colorectal monitoring, CA19-9 for pancreatic, AFP for hepatocellular, CA-125 for ovarian, calcitonin for medullary thyroid, thyroglobulin for differentiated thyroid.

Palliative care: symptom control and quality of life; early integration improves outcomes; discuss advance care planning and preferred place of care.

Cancer genetics: BRCA1/2 for breast and ovarian; Lynch syndrome for colorectal and endometrial; FAP for colorectal; referral to genetics for counselling and testing.

Surveillance after cancer treatment: schedule depends on cancer type and stage; clinical review, imaging, and tumour markers; detect recurrence and second primaries.

Acute limb ischaemia versus critical limb ischaemia: acute onset within 2 weeks; critical is chronic rest pain or tissue loss for more than 2 weeks; management differs (embolectomy versus bypass/angioplasty).

Aortic dissection: sudden tearing chest pain radiating to back; pulse deficit and blood pressure difference between arms; CT angiography diagnostic; urgent blood pressure control and cardiothoracic referral.

Venous thromboembolism: Wells score for probability; D-dimer for low/intermediate probability; CT pulmonary angiography for high probability; anticoagulation for confirmed VTE.

Varicose veins: duplex ultrasound to assess reflux and obstruction; endovenous ablation or surgery for symptomatic disease; compression for conservative management.

Diabetic foot: assess neuropathy, ischaemia, and infection; multidisciplinary foot team; debridement and offloading; revascularisation if ischaemic.

Carotid disease: symptomatic stenosis above 70% warrants endarterectomy or stenting; best medical therapy with antiplatelet and statin.

Abdominal aortic aneurysm screening: ultrasound for men aged 65; surveillance for 3.0-4.4 cm (yearly), 4.5-5.4 cm (3-monthly); repair at 5.5 cm.

Peripheral aneurysm: popliteal most common; repair if symptomatic or above 2 cm; duplex surveillance.

Acid-base: metabolic acidosis with raised anion gap suggests ketoacidosis, lactic acidosis, renal failure, or toxins; normal gap suggests diarrhoea or renal tubular acidosis.

Electrolyte emergencies: hyperkalaemia with ECG changes requires calcium gluconate, insulin-dextrose, and salbutamol; hyponatraemia correction rate should not exceed 10 mmol/L in 24 hours to avoid osmotic demyelination.

Hypovolaemia: assess pulse, blood pressure, capillary refill, urine output; urine output target above 0.5 mL/kg/hour; monitor lactate.

Fluid resuscitation: balanced crystalloid preferred; avoid excessive saline; reassess after each bolus; consider blood products in haemorrhage.

Nutrition assessment: MUST or NRS-2002 screening; dietitian referral for malnourished patients; consider enteral feeding before parenteral.

Refeeding syndrome: monitor phosphate, potassium, and magnesium; start feeding at 10 kcal/kg/day and increase slowly; give thiamine before feeding.

Perioperative glycaemic control: hyperglycaemia increases infection and mortality; target 6-10 mmol/L; avoid hypoglycaemia.

Perioperative renal protection: maintain hydration and perfusion; avoid nephrotoxic drugs; monitor urine output and creatinine.

Trauma team roles: team leader, airway doctor, assessment doctor, procedures doctor, scribe, and runners; closed-loop communication; debrief after major trauma.

Major incident triage: sieve and sort; prioritise according to injury severity; communicate with control; document triage category.

Mass casualty: allocate resources to those most likely to benefit; expectant category for those with unsurvivable injuries; psychological support for staff.

Prehospital care: control catastrophic haemorrhage, airway, breathing, circulation; immobilise spine; transport to major trauma centre.

Transfer: stabilise before transfer; communicate with receiving team; accompany with appropriate staff and equipment.

Trauma audit: review of major trauma cases; identify avoidable factors; improve protocols.

Rehabilitation: early physiotherapy and occupational therapy; plan discharge; social support.

Mental health: screen for PTSD and depression after trauma; refer for psychological support.

Surgical infection: source control is essential; antibiotics alone insufficient for abscess or necrotic tissue; obtain cultures before antibiotics when possible.

Necrotising fasciitis: severe pain out of proportion, rapidly spreading erythema, crepitus, systemic toxicity; urgent surgical debridement and broad-spectrum antibiotics; LRINEC score aids diagnosis.

Gas gangrene: Clostridium perfringens; crepitus, rapid progression, haemolysis; debridement and penicillin; hyperbaric oxygen adjunct.

Tetanus prophylaxis: wound cleaning; booster if not up to date; immunoglobulin for high-risk wounds.

Needlestick injury: wash with soap and water, report immediately, assess source, PEP for HIV and hepatitis B; follow-up serology.

Surgical tuberculosis: consider in endemic areas; biopsy for culture and histology; prolonged multidrug therapy.

Fungal infection: Candida in immunocompromised or prolonged antibiotics; consider in persistent sepsis; antifungal therapy.

Antimicrobial stewardship: avoid unnecessary antibiotics; narrow spectrum based on culture; complete course as prescribed.

Day surgery selection: ASA I-II, stable comorbidity, suitable procedure, social support, and patient preference; avoid in uncontrolled comorbidity or complex procedures.

Anaesthesia types: general, regional, local; preassessment for airway, comorbidities, and medications; fasting guidelines (clear fluids 2 hours, light meal 6 hours).

Enhanced recovery: preoperative counselling, carbohydrate loading, opioid-sparing analgesia, early feeding and mobilisation, and early discharge.

Postoperative pain: multimodal analgesia; regional blocks; patient-controlled analgesia; assess pain score regularly.

Postoperative nausea and vomiting: prophylaxis for high-risk patients; ondansetron and dexamethasone; avoid triggers.

Postoperative mobilisation: early ambulation reduces VTE, pneumonia, and length of stay; physiotherapy input.

Discharge planning: criteria for safe discharge; wound care instructions; follow-up appointment; emergency contact information.

Readmission: identify cause; review medication and social factors; communicate with primary care.

Surgical anatomy: inguinal canal contents (spermatic cord in males, round ligament in females); boundaries (deep ring, superficial ring, inguinal ligament, conjoint tendon).

Femoral triangle: boundaries (inguinal ligament, sartorius, adductor longus); contents (femoral nerve, artery, vein, lymphatics); femoral hernia below and lateral to pubic tubercle.

Calot triangle: cystic duct, common hepatic duct, and inferior border of liver; contains cystic artery; critical view of safety before clipping.

Thyroid blood supply: superior thyroid artery (external carotid), inferior thyroid artery (thyrocervical trunk); recurrent laryngeal nerve in tracheo-oesophageal groove.

Breast anatomy: blood supply from internal thoracic, lateral thoracic, and intercostal arteries; lymphatics to axillary and internal mammary nodes.

Colon anatomy: right colon from SMA, left colon from IMA; watershed area at splenic flexure (Griffith point).

Rectum: above peritoneal reflection anterior, below extraperitoneal; total mesorectal excision removes mesorectum with intact fascia.

Liver segments: Couinaud classification (8 segments); segment IV between middle and left hepatic veins; segment I caudate.

Laparoscopic surgery: pneumoperitoneum with CO2; complications include subcutaneous emphysema, hypercapnia, vagal shock, and gas embolism; monitor end-tidal CO2.

Laparoscopic entry: open Hasson technique or Veress needle; Palmer point for obese patients; check for safe entry with saline test.

Laparoscopic cholecystectomy: critical view of safety; avoid bile duct injury; convert to open if unclear anatomy.

Laparoscopic appendectomy: safe in all trimesters of pregnancy; use low insufflation pressure; consider open if perforated or mass.

Laparoscopic hernia repair: TEP (extraperitoneal) and TAPP (transabdominal preperitoneal); mesh placement; complications include seroma and recurrence.

Robotic surgery: improved dexterity and visualisation; longer operating time and cost; training required.

Single-incision laparoscopy: cosmetic benefit; higher hernia risk; limited evidence.

Conversion to open: do not delay if anatomy unclear, bleeding uncontrolled, or patient unstable; document reason.

Surgical oncology margins: R0 clear, R1 microscopic, R2 macroscopic; margin distance varies by tumour; re-excision for involved margins in breast and melanoma.

Sentinel node biopsy: blue dye and radioisotope; highest node in drainage basin; if positive, complete clearance or radiotherapy.

Peritoneal carcinomatosis: cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC) for selected patients; multidisciplinary assessment.

Liver metastases: resectable disease has good survival; neoadjuvant chemotherapy; ablation for small lesions.

Lung metastases: resection for isolated metastases in selected patients; good prognosis if complete resection.

Bone metastases: bisphosphonates and radiotherapy for pain; orthopaedic fixation for impending fracture.

Brain metastases: steroids for oedema; radiotherapy or surgery for solitary lesion; palliative care.

Paraneoplastic syndromes: SIADH, Cushing syndrome, hypercalcaemia; treat underlying cancer.

Surgical research: formulate question (PICO), design study, obtain ethics approval, collect and analyse data, disseminate findings.

Levels of evidence: systematic reviews and RCTs highest; cohort and case-control lower; case series and expert opinion lowest.

Statistics: sensitivity and specificity for diagnostic tests; positive and negative predictive values depend on prevalence; number needed to treat.

Audit versus research: audit compares practice to standard; research generates new knowledge; ethics approval required for research.

Consent for research: voluntary, informed, capacity; vulnerable participants require additional safeguards.

Data protection: anonymise data; secure storage; share only with consent or legal requirement.

Publication ethics: avoid plagiarism and duplicate publication; declare conflicts of interest; authorship criteria.

Presentation skills: structure (introduction, methods, results, conclusion); rehearse; answer questions clearly.

Surgical teaching: use of simulation, cadavers, and supervised operating; feedback and reflection; competence-based progression.

Assessment tools: DOPS for procedures, mini-CEX for clinical encounters, CBD for case discussions; workplace-based assessments.

Portfolio: logbook of operations, reflections, and assessments; annual review of competence progression (ARCP).

Mentorship: assigned educational supervisor; regular meetings; career advice and support.

Wellbeing: recognise burnout and fatigue; access support services; maintain work-life balance.

Patient safety: report incidents; learn from errors; open disclosure; support colleagues.

Leadership: team management, delegation, and communication; conflict resolution; resource management.

Career planning: explore subspecialties; research and audit opportunities; fellowship applications.

Acute pancreatitis: diagnosis requires 2 of 3 (characteristic pain, lipase/amylase above 3 times upper limit, imaging); severity by Atlanta classification; early enteral feeding.

Gallstone disease: ultrasound first-line; MRCP for suspected duct stones; ERCP for confirmed duct stones with obstruction or cholangitis.

Peptic ulcer: H. pylori testing and eradication; endoscopy for alarm features; perforation requires omental patch.

Upper GI bleeding: resuscitate, risk score, endoscopy within 24 hours; variceal bleeding with terlipressin and band ligation.

Lower GI bleeding: colonoscopy after bowel prep; CT angiography for massive bleeding; embolisation or surgery for uncontrolled bleeding.

Obstruction: CT to identify cause; nasogastric decompression; surgery for strangulation or closed loop.

Perforation: erect chest X-ray for free gas; CT for confirmation; laparotomy for peritonitis.

Ischaemia: CT angiography; laparotomy for necrotic bowel; anticoagulation for venous thrombosis.

Surgical wounds: clean, clean-contaminated, contaminated, dirty; infection risk rises with contamination; prophylactic antibiotics for clean-contaminated.

Wound closure: primary, secondary, tertiary intention; sutures, staples, or glue; choose based on wound and patient factors.

Dressing selection: moist wound healing; alginate for exudate; hydrocolloid for granulating wounds; negative pressure wound therapy for complex wounds.

Scar management: silicone gel or sheets; massage; avoid sun exposure; revise if symptomatic or cosmetic concern.

Keloid and hypertrophic scar: keloid extends beyond wound; hypertrophic within wound; intralesional steroids and pressure therapy.

Wound dehiscence: risk factors include poor nutrition, infection, and increased abdominal pressure; resuture or secondary intention.

Burns wound care: cool running water for 20 minutes; cling film for transfer; avoid ice; analgesia.

Pressure ulcers: risk assessment (Waterlow or Braden); repositioning; pressure-relieving mattress; wound care.

Surgical anatomy of inguinal region: superficial ring above and medial to pubic tubercle; deep ring lateral to inferior epigastric artery; direct hernia through Hesselbach triangle.

Femoral hernia: below and lateral to pubic tubercle; higher risk of strangulation; repair via low approach or laparoscopic.

Umbilical and paraumbilical hernia: repair with mesh for defects above 1 cm; laparoscopic for recurrent or large defects.

Incisional hernia: risk factors include wound infection, obesity, and smoking; repair with mesh; laparoscopic approach for large defects.

Spigelian hernia: through linea semilunaris; rare; repair with mesh.

Lumbar hernia: through inferior lumbar triangle (Petit) or superior (Grynfeltt); repair with mesh.

Obturator hernia: elderly women; presents with bowel obstruction; Howship-Romberg sign; CT diagnostic; surgery.

Diaphragmatic hernia: congenital or acquired; Bochdalek and Morgagni; repair for symptomatic or large defects.

Thyroid nodules: ultrasound features (microcalcification, irregular margins, taller-than-wide) suggest malignancy; FNA cytology by Bethesda system.

Thyroid cancer: papillary (most common, lymphatic spread), follicular (haematogenous), medullary (calcitonin, MEN2), anaplastic (poor prognosis).

Thyroidectomy: total or hemithyroidectomy; recurrent laryngeal nerve identification; parathyroid preservation; postoperative calcium monitoring.

Hyperthyroidism: Graves disease, toxic multinodular goitre, toxic adenoma; antithyroid drugs, radioiodine, or surgery; beta-blockers for symptoms.

Hypothyroidism: levothyroxine replacement; monitor TSH; adjust dose in pregnancy.

Thyroid storm: medical emergency; beta-blockers, antithyroid drugs, iodine, steroids, supportive care.

Parathyroid: primary hyperparathyroidism most commonly adenoma; surgery for symptomatic or severe disease; sestamibi and intraoperative PTH.

Adrenal: incidentaloma assessment; phaeochromocytoma alpha blockade before surgery; Conn syndrome and Cushing syndrome.

Breast assessment: triple assessment (clinical, imaging, pathology); ultrasound for under 40, mammography for 40 and over; core biopsy for solid lesions.

Breast cancer: TNM staging; receptor status (ER, PR, HER2); treatment by MDT; breast-conserving surgery or mastectomy.

Sentinel node biopsy: blue dye and radioisotope; axillary clearance for 2 or more positive nodes.

Benign breast disease: fibroadenoma, cyst, papilloma, fat necrosis; differentiate from malignancy; biopsy if uncertain.

Breast infection: lactational mastitis and abscess; antibiotics and drainage; continue breastfeeding.

Gynaecomastia: physiological, drug-induced, or pathological; investigate if unilateral or rapid growth.

Male breast cancer: rare; often ER positive; BRCA2 association; treatment similar to female.

Breast reconstruction: immediate or delayed; implant or autologous flap; discuss options with patient.

Colorectal cancer: right-sided presents with anaemia and mass; left-sided with obstruction; rectal bleeding warrants colonoscopy.

Staging: CT chest, abdomen, and pelvis; MRI for rectal cancer; PET-CT for selected cases.

Surgery: right hemicolectomy, left hemicolectomy, anterior resection, abdominoperineal resection; total mesorectal excision for rectal cancer.

Adjuvant therapy: chemotherapy for stage III and high-risk stage II; radiotherapy for rectal cancer.

Surveillance: clinical review, CEA, and imaging; colonoscopy at 1 year and then according to findings.

Hereditary syndromes: FAP and Lynch syndrome; genetic testing and surveillance.

Obstruction: stent as bridge to surgery or emergency resection; Hartmann procedure for perforated left colon.

Metastases: resectable liver and lung metastases; chemotherapy; ablation.

Acute abdomen in the elderly: atypical presentation; lower threshold for CT and surgical review; higher mortality.

Diverticulitis: Hinchey classification; CT diagnostic; antibiotics for complicated disease; surgery for perforation or abscess.

Mesenteric ischaemia: pain out of proportion; CT angiography; laparotomy for necrotic bowel.

Bowel obstruction: CT to identify transition point and strangulation; nasogastric decompression; surgery for closed loop or strangulation.

Perforation: free gas on erect chest X-ray; CT for confirmation; laparotomy for peritonitis.

Appendicitis: Alvarado score; ultrasound or CT; laparoscopic appendectomy.

Cholecystitis: Tokyo Guidelines; early cholecystectomy; antibiotics.

Pancreatitis: Atlanta classification; early enteral feeding; ERCP for cholangitis.

Trauma primary survey: catastrophic haemorrhage control, airway, breathing, circulation, disability, exposure; adjuncts and reassessment.

Secondary survey: head-to-toe examination; log roll; document findings; reassess ABCs.

Haemorrhage control: direct pressure, tourniquet, pelvic binder, tranexamic acid; massive transfusion protocol.

Head injury: GCS, pupils, CT within 1 hour for indications; neurosurgical referral.

Chest trauma: chest drain for pneumothorax or haemothorax; analgesia for rib fractures; thoracotomy for massive haemothorax.

Abdominal trauma: FAST for unstable; CT for stable; laparotomy for peritonitis or instability.

Pelvic fracture: binder, angioembolisation, orthopaedic fixation.

Burns: Parkland formula; airway assessment; escharotomy for circumferential burns.

Perioperative assessment: history, examination, investigations; ASA grade; functional capacity; cardiac and respiratory risk.

Investigations: full blood count, urea and electrolytes, coagulation, group and save; ECG and chest X-ray for selected patients.

Medication management: continue beta-blockers and statins; stop clopidogrel; bridge anticoagulation.

Fasting: clear fluids 2 hours, light meal 6 hours; carbohydrate loading for ERAS.

Prophylaxis: VTE assessment and prophylaxis; antibiotic prophylaxis within 60 minutes of incision.

Consent: risks, benefits, alternatives; capacity assessment; documentation.

Marking the site: surgical site marking for procedures with laterality; check in theatre.

WHO checklist: sign in, time out, sign out; reduces errors.

Postoperative fever: timing guides cause; atelectasis early, UTI and pneumonia days 3-5, SSI and leak days 5-7, abscess days 7-10, VTE after 10 days.

Postoperative hypoxia: atelectasis, aspiration, PE, pneumonia; chest X-ray and CT pulmonary angiography.

Postoperative hypotension: hypovolaemia, sepsis, MI, PE, tamponade; assess and investigate.

Postoperative oliguria: hypovolaemia, obstruction, renal failure; catheterise and monitor.

Postoperative ileus: generalised, painless; self-limiting; CT if prolonged.

Postoperative bleeding: assess wound, drains, and haemoglobin; re-exploration for uncontrolled bleeding.

Wound infection: antibiotics and drainage; dehiscence requires resuture.

Anastomotic leak: tachycardia, fever, peritonitis; CT with contrast; re-laparotomy and diversion.

Shock: hypovolaemic, cardiogenic, distributive, obstructive; management by cause.

Sepsis: qSOFA, SOFA; sepsis six; antibiotics within 1 hour; fluids 30 mL/kg; vasopressors for MAP below 65.

Anaphylaxis: adrenaline 0.5 mg IM; airway support; antihistamines and steroids adjuncts.

Cardiac arrest: ALS algorithm; chest compressions; defibrillation for shockable rhythms.

Acute coronary syndrome: ECG and troponin; aspirin and clopidogrel; cardiology referral.

Pulmonary embolism: Wells score, D-dimer, CT pulmonary angiography; anticoagulation.

Acute kidney injury: assess volume, obstruction, nephrotoxins; monitor urine output and creatinine.

Hyperkalaemia: ECG changes; calcium gluconate, insulin-dextrose, salbutamol.

Surgical ethics: autonomy, beneficence, non-maleficence, justice; apply to consent, resource allocation, and research.

Consent: valid consent requires capacity, information, and voluntariness; document discussion.

Capacity: assess understanding, retention, communication, and reasoning; best interests if lacking capacity.

Confidentiality: share on need-to-know basis; disclose without consent only when required by law or public interest.

Duty of candour: disclose harm, apologise, document, and report.

Professional boundaries: avoid conflicts of interest; declare gifts and relationships.

Fitness to practise: maintain competence, CPD, and health; seek help for burnout.

Research ethics: ethics approval, informed consent, data protection, and publication ethics.

Clinical examination: systematic approach; inspect, palpate, percuss, auscultate; compare sides.

Abdominal examination: inspect for scars and distension; palpate for masses and organomegaly; check hernia orifices; digital rectal examination.

Breast examination: inspect with arms up and hands on hips; palpate quadrants; check axilla and supraclavicular fossa.

Thyroid examination: inspect with swallow; palpate from behind; assess for retrosternal extension.

Vascular examination: inspect for ulcers; palpate pulses; auscultate for bruits; measure ABPI.

Trauma examination: primary and secondary survey; log roll; reassess.

Documentation: record findings clearly; include date, time, and signature.

Communication: explain findings to patient; involve in decision-making.

Surgical oncology: en bloc resection; clear margins; sentinel node biopsy; MDT discussion.

Neoadjuvant therapy: downstages locally advanced tumours; used in rectal, oesophageal, and breast cancer.

Adjuvant therapy: after resection; chemotherapy, radiotherapy, or endocrine therapy depending on cancer.

Tumour markers: CEA, CA19-9, AFP, CA-125, calcitonin, thyroglobulin; use for monitoring, not screening.

Palliative care: symptom control; early integration; advance care planning.

Cancer genetics: BRCA, Lynch, FAP; referral for counselling and testing.

Surveillance: schedule depends on cancer type and stage; detect recurrence and second primaries.

Rehabilitation: physiotherapy and occupational therapy; psychological support.

Vascular emergencies: acute limb ischaemia, ruptured AAA, aortic dissection; urgent assessment and intervention.

Acute limb ischaemia: 6 Ps; heparin; embolectomy or bypass; compartment syndrome risk.

Ruptured AAA: back pain, hypotension, pulsatile mass; urgent CT or straight to theatre; permissive hypotension.

Aortic dissection: tearing chest pain; pulse deficit; CT angiography; blood pressure control.

Carotid disease: symptomatic stenosis above 70%; endarterectomy or stenting; medical therapy.

Diabetic foot: multidisciplinary team; debridement; revascularisation; offloading.

Varicose veins: duplex ultrasound; endovenous ablation or surgery; compression.

VTE: Wells score; D-dimer; CT pulmonary angiography; anticoagulation.

Fluid and electrolyte: maintenance 25-30 mL/kg/day; sodium and potassium 1 mmol/kg/day; balanced crystalloids preferred.

Acid-base: anion gap; metabolic acidosis causes; compensation.

Nutrition: MUST or NRS-2002 screening; enteral before parenteral; refeeding syndrome risk.

Perioperative glycaemic control: target 6-10 mmol/L; avoid hypoglycaemia.

Renal protection: hydration; avoid nephrotoxins; monitor urine output.

Electrolyte emergencies: hyperkalaemia, hyponatraemia; urgent treatment.

Blood transfusion: restrictive threshold; check identity; monitor for reactions.

Transfusion reactions: stop transfusion; investigate; manage according to type.

Trauma team: roles and communication; closed-loop; debrief.

Major incident: triage; prioritise; communicate; document.

Prehospital care: catastrophic haemorrhage control; airway; breathing; circulation; transport.

Transfer: stabilise; communicate; accompany with appropriate staff.

Trauma audit: review cases; identify avoidable factors; improve protocols.

Rehabilitation: early physiotherapy; plan discharge; social support.

Mental health: screen for PTSD and depression; refer for support.

Leadership: team management; delegation; conflict resolution.

Surgical infection: source control; antibiotics; cultures.

Necrotising fasciitis: urgent debridement; broad-spectrum antibiotics; LRINEC score.

Gas gangrene: debridement; penicillin; hyperbaric oxygen adjunct.

Tetanus prophylaxis: wound cleaning; booster; immunoglobulin for high-risk wounds.

Needlestick injury: wash; report; PEP; follow-up serology.

Surgical tuberculosis: consider in endemic areas; biopsy; multidrug therapy.

Fungal infection: Candida; antifungal therapy; consider in persistent sepsis.

Antimicrobial stewardship: avoid unnecessary antibiotics; narrow spectrum; complete course.

Day surgery: ASA I-II; suitable procedure; social support; patient preference.

Anaesthesia: general, regional, local; preassessment; fasting guidelines.

Enhanced recovery: counselling; carbohydrate loading; opioid-sparing; early feeding and mobilisation.

Postoperative pain: multimodal analgesia; regional blocks; assess pain score.

PONV: prophylaxis for high-risk; ondansetron and dexamethasone.

Mobilisation: early ambulation; physiotherapy.

Discharge planning: criteria; wound care; follow-up; emergency contact.

Readmission: identify cause; review medication and social factors.