Surgery Rotation Advice

Exams:
There are 3 parts:
1) Viva
2) Slideshow Quiz
3) MCQ/EMQ/Written Exam

Viva:
These were the stations I got and what they entailed:
Station 1: Lady with several pictures of a chest tube, large ulcer on plantar surface of foot,
picture with massive varicose veins.
I was asked to identify the varicose veins, what venous system I believed was defective, where
the defect was and what my surgical treatment option would entail. Disadvantage of venous
stripping, anatomy of the venous system, and treatment for the large ulcer on the foot.

Station 2: White Book Station.

The case I picked to present was Breast Cancer. I was asked about risk factors for breast
cancer, types of breast cancer, benign diseases of the breast and when a fibroadenoma can be
malignant.

Station 3: Guy with several instruments.

He asked me what the purpose of the purple IV is, which IV gauge I would use for a patient in
hemorrhagic shock, what the purpose of the three way catheter is, 5 functions of the three way
catheter, to identify pneumatic compression stockings and when it is indicated, how to insert a
catheter, what is contained within a 0.9% saline bag and Lactated Ringer’s Solution.

Station 4: Lady with several X-rays and Ultrasounds:

I was asked to identify acute cholecystitis on an ultrasound, features of an ultrasound that
suggest acute cholecystitis and how it differentiates from cholelithiasis, then identify
choledocholithiasis on a cholangiogram, clinical features of choledocholithiasis, causes of
obstructive jaundice, an Xray of LBO, the most common cause of LBO, an Xray of SBO, the
most common cause of SBO, how to differentiate SBO and LBO on an Xray, then a picture of a
massive GI bleed, and she asked me causes of a massive GI bleed, and how to differentiate an
UGI bleed from a LGI bleed.

Station 5: Guy with several pictures of butts (yes, there was a station dedicated to butt stuff).
Guy asked me to diagnose a perianal fistula, what Goodsall’s Rule is, differentials for a large
groin mass, difference between an inguinoscrotal hernia and a hydrocele, types of repairs for a
hernia, difference between TEPP and TAPP, diagnose a thrombosed interoexternal hemorrhoid,

Slideshow Quiz:
Station 1: Picture of Lactated Ringer’s Bag
Q: What are the electrolytes in this bag?
A: Lactate (NOT HCO3-), Na, K, Ca, Cl

Station 2: Bag of albumin

Q: What is the main difference between the last bag and this bag?
A: Bag of albumin is a colloid, while lactated ringers is crystalloid.

Station 3: 4 needles with different gauges and needle lengths.

Q: Which needle delivers the fastest?
A: Needle with lowest gauge and shortest length.

Station 4: What Law did you use to determine the above rule?
A: Pouisille’s Law (I slaughtered that spelling :’( )

** Can’t remember the order to well from this point but I remember most of the questions:
Station 5: CT Scan of a ruptured spleen.
Q: What emergency operation is needed, and what is 1 known complication of this procedure?
A: Splenectomy, infection by encapsulated organisms.

Station 6: CT Scan of large collection of fluid around the left side of the abdomen:
Q: What is this condition?
A: Acute pancreatitis

Station 7: CT Scan of greatly enlarged mass on left side of body:

Q: What is this complication that occurred 6 weeks after the scenario in Station 6?

A: Pancreatic Pseudocyst

Station 8: CT Scan of a shrunken mass on left side of body:

Q: This complication occurred after several years. What is it?
A: Chronic pancreatitis.

Station 9: Picture of unilateral swollen leg.

Q: What is one way to prevent this? (DVT)
A: TED stockings, IV heparin, early ambulation

Station 10: Xray of Large peripheral dilation of the bowels.

Q: What condition is this?
A: Large Bowel Obstruction.

Station 11: Xray of air under the liver.

Q: This occurred after as a complication of Station 10. What has happened, where is the defect
and what law does the answer to this question refer to?
A: Pneumoperitoneum, Cecum, Law of Laplace.

Station 12: Pictures of varicose veins.

Q: What system is affected?
A: Venous system.

Station 13: Picture of ulcer at the bottom of a patient’s enlarged, abnormal looking feet.
Q: What is the type of ulcer, and what is the condition for the patient’s feet called?
A: Neuropathic ulcer, Charcot’s Foot.
Station 14: Picture of a patient’s laparotomy surgery with several structures visualized, including
the liver, a Morris retractor, the omentum, the stomach and the linea alba. He asked to label
each structure.

Station 15: Picture of sebaceous cyst.

Q: What are its pathognomonic characteristics?
A: Punctum, attachment to skin.

Written:
SAQ:
1) Chest Trauma: Patient with icepick injury to the chest, absent breath sounds unilaterally and
respiratory distress.
1) Diagnosis?
2) How would you manage this patient immediately?
3) When would you refer this patient for a thoracotomy?

2) 18 year old Woman with RLQ pain and 1+1.

i) What 2 radiological investigations?
ii) What 3 lab investigations?
iii) What are the differentials?

3) Was on LBO vs SBO. Can’t remember the questions too well.

Sources to Study:
The ones I used are mainly 1, 2 and 3, but I referred to the other books from time to time.
1) Surgical Recall and Advanced Surgical Recall (they say not to use it but they’re just hating
because this book helps you cram like a champion).
2) Browse Symptoms and Signs in Surgical Disease: Fantastic for lumps and bumps and
ulcers, and for learning the signs and symptoms of the common diseases. You have to
100% read this book.
3) Deja Review Surgery: Another fantastic cramming book that I used with the Surgical Recall.
*(Yes, I survived surgery using cramming books).

4) Bailey’s: Perfect for SBO and LBO, and useful as an adjunct for other topics.
5) Uptodate
6) Surgeons in Grande Hospital (these guys LOVE to teach)
7) Schwartz Surgery: EXTREMELY condense and difficult to read book, really meant for DM
students. Most of what I got from this book didn’t really help me in the exam because they
don’t really ask advanced level questions, but it did help when surgeons on the ward tried to
drown you with questions.

The ones other people used and recommended strongly are:

8) Lecture Notes In General Surgery: Perfect as an introduction to topics.
9) Fast Track Surgery: Similar to Deja Review Surgery and Surgical Recall.