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Comprehensive Surgical Clerkship Lectures

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Muhammad Yaqut
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38 views12 pages

Comprehensive Surgical Clerkship Lectures

Uploaded by

Muhammad Yaqut
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Senior Clerkship Lectures

Surgery

Emergency

• General approach to trauma 3


• General approach to trauma LGW
• Surgical emergency (abdominal trauma) 5
• Triage in surgical emergencies 2
• Triage in surgical emergencies CBL
• Head trauma 5
• Head trauma LGW
• Thoracic trauma 4
• Thoracic trauma LGW
• Traumatic surgical emergencies –SE CBL
• Acute abdomen –SE CBL 5
• Infections as a surgical emergency – SE CBL
• Traumatic surgical emergencies (Primary survey) – SE CBL
• Traumatic surgical emergencies (Secondary survey) – SE CBL
• Archives of infections and acute abdomen 5

Orthopedics

1. Trauma care and advanced fractures 3


2. Orthopedics emergencies 5
3. Introduction to orthopedics 1
4. Basic science of bone diseases 1
5. Principles of fracture management 3
6. Orthopedics imaging 2
7. Common fractures 5
8. Fracture complications 5
9. Shoulder and elbow 5
10. Hand disorders 5
11. Bone and joint infections
12. Foot and ankle disorders 5
13. Sports injuries 3
14. Joint reconstructions 1
15. Orthopedic oncology 2
16. Spine disorders 3
17. Knee examination clinical
18. Shoulder examination clinical
19. Hip examination clinical
20. Orthopedics applied anatomy 2
21. UL surgical anatomy 2
22. LL surgical anatomy 2
23. Pediatric hip conditions 1
24. Misc. pediatric conditions i2
Plastic

• Burns 5
• Burns LGW
• Principles of plastic surgery 1
• Principles of plastic surgery LGW

Breast

• Palpable breast masses 5


• Screen-detected breast pathology 3
• Benign breast diseases 5
• Benign breast diseases LGW
• Malignant breast diseases 5
• Malignant breast diseases LGW
• Management of cancer breast 5
• Breast anatomy and physiology 1
• Breast examination clinical

Vascular

1. Occlusive vascular emergency 5


2. Acute arterial ischemia and vascular trauma 5
3. Chronic arterial ischemia 5
4. Venous vascular disease 5
5. Venous vascular diseases LGW
6. Diabetic foot 5
7. Diabetic foot LGW
8. Aneurysms 3
9. Aneurysms LGW
10. Chronic limb swelling 4
11. Chronic limb swelling LGW
12. Principles of limb ablation supportive therapy 1
13. Extracranial, renal, and mesenteric ischemia 4
14. Overview of vascular diseases – surgery revision 2
15. Vascular history taking and examination clinical

Emergencies

16. Limb vascular injuries 5


17. Abdominal vascular emergency 5

Hepatobiliary:

• Surgical overview of biliary-pancreatic anatomy and physiology 1


• Management of symptomatic and complicated gall stones 5
• Surgical revision of hepatobiliary and pancreatic systems 5
• Interactive GIT revision (hepatobiliary) 5
• LGW bilio-pancreatic diseases
• Biliary diseases 5
• Obstructive jaundice 5
GIT
1. Dysphagia 5
2. Altered bowel habits 5
3. Altered bowel habits LGW
4. Upper GIT hemorrhage 5
5. Lower GIT hemorrhage 5
6. GIT hemorrhage SCS 5
7. Gastric carcinoma 3
8. Cancer esophagus 3
9. Principles of management of gastric malignancies 2
10. Management of colorectal malignancy 5
11. Surgery of spleen 2
12. Peripheral nerve injuries 3
13. Transplant surgery 1
14. Principles of management of complicated PUD 5
15. Acute abdomen 5
16. Abdominal trauma 5
17. Abdominal trauma LGW
18. Intestinal obstruction 5
19. Approach to intestinal obstruction 5
20. Approach to peritonitis 5
21. Appendix surgery 4
22. Diverticular disease of the colon 4
23. Surgical management of complicated IBD 3
24. Esophageal traumatic emergencies 2
25. DDx of abdominal masses 5
26. Interactive GIT revision (gastroduodenal) 5
27. Interactive GIT revision (intestines) 5
28. Clinical overview of small and large intestines 3
29. Overview of GIT applied anatomy 2
30. Clinical overview of gastric diseases 3
31. Clinical overview of esophageal diseases 3
32. History taking in patients with abdominal complaints clinical
33. Surgical examination checklist clinical

34. Common anal complaints 5


35. Obstructed defecation and fecal incontinence 5
36. Rectal prolapse 2
37. Septic anorectal conditions 5
38. Non-septic anorectal diseases 5
39. Pilonidal sinus 5
40. Algorithmic approach to anorectal conditions 5

Urology

• Obstructive uropathy 5
• Renal tumors 3
• Suprarenal tumors 2
• Testicular tumors 1
Endocrine

• Acute pancreatitis 5
• Chronic pancreatitis 3
• Pancreatic carcinoma 5

Head and neck

• Thyroid gland 5
• Salivary Gland 5
• Parathyroid diseases 2
• DDx of neck masses 5

Hernia + Swellings

• Abdominal hernia 5
• Ventral hernia 3
• Inguinoscrotal swellings 5

Laparoscopic surgery

• Laparoscopic surgery 1
• Bariatric surgery 1

General

• Hand infections 5
• Wound care lecture 2
• Wound care LGW
• Pre-operative care 2
• Operative care 1
• Post-operative care 2
• Intra-operative patient safety 2
• Infections 5
• Etiquette of surgical theater 1
• Shock 5
• Principles of oncology 1
• Nutrition 1
• Homeostasis and stress response to surgery 4
Internal Medicine

Nephrology
• Introduction to kidney diseases 1
• Acute kidney injury 5
• AKI LGW
• Clinical approach to patient with AKI – SCM 25.1 5
• Chronic kidney disease 5
• CKD LGW
• Renal replacement therapy 2
• Interstitial nephritis 5
• UTI 5
• Glomerulonephritis 5
• Glomerulonephritis LGW
• Acid base electrolytes 5
• Acid base LGW
• Sodium disorders 5
• Potassium disorders 5
• Fluids and electrolytes 2
• Hydration assessment 2
• Clinical chemistry of renal functions 3
• Urine microscopic examination 3
• Urinalysis practical session 3
• Urological problems and the kidney 5

Rheumatology
1. Autoimmunity rheumatic diseases 2
2. Rheumatoid arthritis 5
3. SLE 5
4. Inflammatory myopathy 2
5. Raynaud’s phenomenon and scleroderma 5
6. Vasculitis 1 5
7. Vasculitis 2 5
8. The acute swollen joint 4
9. Rheumatology clinical reasoning 5
10. Diagnostic methods of rheumatic diseases 4
11. FMF 4
12. Spondylitis 5
13. Approach to patient with low back pain 5
14. Rheumatology imaging 2
15. Osteoarthritis 5
16. Rheumatology cases revision SCM 29.1
17. Rheumatology LGW 3.8.1
18. Rheumatology cases
Gastroenterology and hepatobiliary
1. Colorectal cancer 3
2. GERD 5
3. IBD 5
4. PUD 5
5. Diarrhea 5
6. Malabsorption 4
7. Role of endoscopy 1
8. Malaria 5
9. Helminths 2
10. Brucella 5
11. Functional GI disorders 5
12. Constipation 5
13. Intestinal failure 1
14. Artificial feeding 1
15. GIST and neuroendocrine tumors 1
16. GI bleeding 5

17. Hepatobiliary malignancies 2


18. Metabolic liver disease 5
19. Viral hepatitis 1 5
20. Viral hepatitis 2 5
21. Non-viral hepatitis 5
22. Liver cirrhosis 5
23. Portal hypertension 5
24. Liver transplantation 1
25. Amoebic liver abscess 5
26. Hydatid disease 5
27. Alcoholic liver disease 2
28. Jaundice 5
29. Cholestatic liver disease 5
30. Vascular disorders of liver 2
31. Acute liver failure 3

32. Pancreatic disorders 4


Hematology
Coagulation, hemostasis, and bleeding disorders
1. Bleeding disorders cases
2. Thrombocytopenia 1 5
3. Thrombocytopenia 2 5
4. Platelet coagulation and hemostasis 2
5. Hemophilia 5
6. VWD 5
7. Practical approach to bleeding disorders 5

Coagulopathies
8. DVT and pulmonary embolism 5
9. Anti-platelets and anticoagulant therapy 2
10. Anti-coagulant therapy Q and A 3
11. Thrombophilia student notes
12. Thrombophilia part 2 5

Hereditary and acquired anemias


13. Sickle cell disease 5
14. Preoperative SCA 2
15. Approach to hemoglobinopathies 5
16.
17. Thalassemia 5
18. Approach to anemia 5
19. Approach to anemia S.N
20. Deficiency anemias; megaloblastic anemia 5
21. Iron deficiency anemia 5
22. Hemolytic anemia 5
5
23. Hereditary anemia and enzyme deficiency

Hematological changes in systemic disease


24. Hematological changes in systemic diseases 2
25. Hematological changes in systemic diseases LGW

Hematological malignancies and bone marrow failure


26. Myeloid neoplasms 5
27. Bone marrow failure 2
28. Lymphoid malignancies 5
29. Lymphomas 5
30. Stem cell transplant 1
31. Multiple myeloma 5
32. Pathology of lymphoma 1
33. Pathology of lymphoma LGW
34. Chemotherapeutics 1

35. Paraproteinemia part 1 2


36. Proteins and paraproteinemia 2 2
37. Proteins and paraproteinemia SDL
Basics
38. Blood components 1
39. Blood grouping 4
40. Blood group mcq
41. Appropriate use of blood transfusion 1
42. Adverse transfusion reactions 5
43. Appropriate use of blood components 1
44. Red cell antigens and pre-transfusion testing 1
45. Practical session principle of cross matching clinical

Miscellaneous

46. Introduction to hematological emergencies 5


47. Introduction to hematological emergencies S.N
48. Hematology case LGW 092
49. Spleen 2
50. ICC 3 - 109 hematology cases
51. Hemostasis Q and A
52. Hematology emergencies 5
53. Hematology emergencies LGW
54. ICC 2 – 046 hematology SGW

55. Pentose phosphate pathway LGW


56. Carbohydrate metabolism 1
57. Tutorial questions

Critical lab values


58. Hemoglobin assay 1
59. Hematology bench aid revision 1
60. Film preparation 1
Cardiology

1. Final cardiology revision 5


2. CAD and MI LGW
3. Infective endocarditis 5
4. Infective endocarditis LGW
5. Acute coronary syndrome 5
6. Biochemical assay of cholesterol 1
7. Hyperlipidemia LGW
8. Acute heart failure 5
9. Pericardial diseases 5
10. Cardiomyopathies 5
11. Coronary artery disease 5
12. Heart failure 5
13. Heart murmurs auscultation clinical
14. Valvular heart disease 5
15. Aortic dissection 3
16. Hypertension LGW 5
17. Clinical therapeutics 5
18. Cardiac emergencies 5

ECG 5
19. Basics of ECG interpretation
20. ECG interpretation
21. ECG workshop
22. Tachyarrhythmias and bradyarrhythmia
23. Tachyarrhythmias and bradyarrhythmia part 1
24. Tachyarrhythmias and bradyarrhythmia part 2
Chest
1. Respiratory emergencies SCM
2. Respiratory emergencies 5
3. Mediastinum 3
4. Sleep disordered breathing 2
5. Pulmonary hypertension – SCM 5
6. COPD, Asthma, and interstitial lung disease (pathology) 1

7. Asthma 5
8. Asthma LGW

9. COPD 5
10. COPD LGW

11. Lung tumors (pathology)


12. Pneumonia 5
13. CAP LGW
14. HAP 5
15. Bacterial infections of the LRT 5
16. Wheezy chest 5

17. Diagnosis of TB 5
18. Treatment of TB 5
19. Extra-pulmonary TB 2
20. TB radiology 1

21. Pulmonary function tests 5

22. Bronchogenic carcinoma 5


23. Bronchogenic carcinoma LGW

24. Basic CXR interpretation radiology


25. Thromboembolic disease imaging radiology

26. Interstitial lung disease 5


27. Interstitial lung disease LGW

28. Occupational lung diseases 3


29. Clinical therapeutics 5
30. Non-tuberculous mycobacterium 1
31. Pleura LGW 5
32. Abscess 5
33. Bronchiectasis 5
34. Filariasis 2
35. ABG workshop 5
36. Chest revision
Endocrine disorders and diabetes
1. Diabetes Mellitus 5
2. Pathology of DM handout
3. DM complications 5
4. DM therapeutics 5
5. DM treatment and complications LGW 5

6. Thyroid disorders LGW 5


7. Hyperthyroidism 5
8. Thyroid hypofunction 5
9. Thyroid Nodules 5

10. Diabetes insipidus and SIADH 5


11. Endocrine common presentations 5

12. Pathology of adrenals 5


13. Secondary hypertension 5
14. Pheochromocytoma 5

15. Dynamic endocrine testing 5


16. Endocrine Emergencies 5

17. Parathyroid gland and calcium metabolism 5


18. Osteoporosis 5
19. Metabolic syndrome 3
20. Obesity
OSCE Checklists

1. Hernia examination
2. Varicose veins examination
3. Vascular examination
4. Parotid gland examination
5. Peripheral nerve injuries examination
6. Breast examination
7. Hip examination
8. Knee examination
9. Shoulder examination
10. Rheumatology history taking
11. Rheumatology examination
12. Hematology history taking
13. Abdominal history taking
14. Abdominal examination
15. Chest history taking
16. Chest examination
17. Cardiac history taking
18. Cardiac examination
19. Nephrology history taking
20. Endocrine history taking
21. Thyroid examination

Common questions

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Triage in surgical emergencies determines the priority of patients' treatments based on the severity of their conditions. Effective triage ensures that resources are allocated appropriately, which is crucial in scenarios with limited medical resources. Proper triage positively impacts patient outcomes by reducing mortality rates, preventing overcrowding in emergency departments, and ensuring swift treatment of critically ill patients .

A comprehensive approach to abdominal trauma involves prompt diagnosis, resuscitation, and surgical intervention. It requires integrating clinical evaluation, imaging, and surgical principles to manage life-threatening hemorrhages or organ perforations. Rapid and accurate assessment, followed by timely operative or non-operative management based on injury severity, significantly improves survival rates and reduces complications .

Acute pancreatitis generally focuses on supportive care, including fluid resuscitation, pain control, and nutritional support, with surgery reserved for complications like necrosis or abscess. Chronic pancreatitis, however, may require surgical intervention to manage pain or complications such as obstructive jaundice or duodenal obstruction, and procedures like pancreatic duct drainage or resection might be considered .

Vascular emergencies, such as acute arterial ischemia, can lead to severe systemic complications like organ failure if untreated. They should be prioritized based on the risk of tissue death, with early recognition and prompt intervention crucial. Rapid restoration of blood flow, often through endovascular techniques or surgical revascularization, can prevent irreversible damage and significantly affect systemic health outcomes .

The primary survey in traumatic surgical emergencies involves evaluating and addressing life-threatening conditions in a structured manner. It includes the assessment of airway with cervical spine protection, breathing and ventilation, circulation with hemorrhage control, disability or neurological status, and exposure or environmental control. This approach is essential for quick identification and management of critical injuries that could lead to fatal outcomes if not promptly addressed .

Obesity is closely linked to endocrine disorders like diabetes mellitus and metabolic syndrome. Surgical options, such as bariatric surgery, can significantly impact these conditions by inducing weight loss and improving metabolic parameters. Procedures like gastric bypass or sleeve gastrectomy alter gut hormones that regulate insulin sensitivity and appetite, providing a potential solution for long-term control of obesity-related endocrine disorders .

Untreated obstructive sleep apnea can lead to cardiovascular problems, neurocognitive effects, metabolic dysfunction, and increased risk of accidents due to daytime sleepiness. Surgical interventions, such as uvulopalatopharyngoplasty or maxillomandibular advancement, can mitigate these risks by addressing anatomical causes of airway obstruction, thereby improving airway patency and sleep quality .

Fracture management is based on restoration of function by anatomical alignment and ensuring proper healing. Common fractures, like those of the wrist or hip, require different approaches. Wrist fractures often involve conservative treatment with casting, while hip fractures might necessitate surgical intervention for internal fixation. Each type poses unique challenges, such as the risk of avascular necrosis in femoral neck fractures or malunion in wrist fractures, which dictate specific management strategies .

Acute kidney injury is characterized by a rapid decline in kidney function over hours to days, often reversible, and is identified by rising blood creatinine or reduced urine output. Chronic kidney disease is a long-term condition where kidney function deteriorates over months to years, often identified by persistent high creatinine and uremia. Differentiating these is crucial for treatment, as AKI might require immediate interventions like dialysis, while CKD management focuses on slowing progression .

Managing infections as surgical emergencies involves addressing life-threatening conditions such as sepsis or necrotizing fasciitis. Challenges include timely diagnosis amidst ambiguous presentations and antibiotic resistance. Strategies involve immediate broad-spectrum antibiotics, supportive care, and surgical debridement. Multidisciplinary approaches enhance outcomes by integrating surgical, medical, and critical care expertise .

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