-
Take a focused surgical history and elicit and interpret physical signs to reach a differential diagnosis.
18 questions
-
Recognise surgical emergencies and begin resuscitation using a structured approach.
8 questions
-
Select and interpret appropriate investigations, including plain radiographs and ultrasound, with regard to cost and availability.
10 questions
-
Assess and prepare a patient for operation and provide safe postoperative care, including fluids, analgesia and thromboprophylaxis.
25 questions
-
Describe the principles of the common operations, their complications and their outcomes.
21 questions
-
Apply knowledge of the surgical disease burden in Ghana, including trauma, burns, late-presenting malignancy and tropical disease.
12 questions
-
Describe the anaesthetic assessment, fluid and transfusion therapy, pain relief and monitoring of the critically ill surgical patient.
26 questions
Surgery
-
Take a focused surgical history and elicit and interpret physical signs to reach a differential diagnosis.
18 questions
-
Recognise surgical emergencies and begin resuscitation using a structured approach.
8 questions
-
Select and interpret appropriate investigations, including plain radiographs and ultrasound, with regard to cost and availability.
10 questions
-
Assess and prepare a patient for operation and provide safe postoperative care, including fluids, analgesia and thromboprophylaxis.
25 questions
-
Describe the principles of the common operations, their complications and their outcomes.
21 questions
-
Apply knowledge of the surgical disease burden in Ghana, including trauma, burns, late-presenting malignancy and tropical disease.
12 questions
Preoperative assessment
-
Outline the components of preoperative assessment: history, examination, assessment of comorbidity, medication review and airway assessment
20 questions
-
Select preoperative investigations according to the patient, the proposed procedure and available resources
16 questions
-
Apply risk stratification, including ASA grading, and identify patients who need optimisation or specialist referral
23 questions
-
Outline preoperative preparation: fasting, consent, thromboprophylaxis, antibiotic prophylaxis and the management of anticoagulants, antihypertensives and insulin
12 questions
Postoperative care and complications
-
Outline routine postoperative care: monitoring, fluids, analgesia, nutrition and early mobilisation
17 questions
-
Classify postoperative complications as immediate, early or late, and by system
16 questions
-
Recognise and manage postoperative pyrexia, wound infection, wound dehiscence, atelectasis, ileus and venous thromboembolism
21 questions
-
Recognise the deteriorating postoperative patient and outline an escalation plan
29 questions
Medical problems in surgical patients
-
Describe how diabetes, hypertension, sickle cell disease, HIV, chronic kidney disease and anaemia affect surgical risk
17 questions
-
Outline the perioperative management of diabetes, anticoagulation and long-term corticosteroid therapy
13 questions
-
Recognise the perioperative complications of sickle cell disease and outline their prevention
8 questions
Enteral and parenteral nutrition
-
Describe the metabolic response to injury and the consequences of malnutrition in surgical patients
14 questions
-
Assess nutritional status and estimate energy and protein requirements
9 questions
-
Compare enteral and parenteral nutrition by indication, route and complications, including refeeding syndrome
14 questions
Hospital infection and sterilisation techniques
-
Describe the sources and routes of hospital-acquired infection and the risk factors for surgical site infection
8 questions
-
Compare sterilisation and disinfection methods and state where each is appropriate
12 questions
-
Outline prevention: hand hygiene, aseptic technique, theatre discipline, antibiotic prophylaxis and safe waste handling
13 questions
Instruments and sutures
-
Identify the common surgical instruments and state the use of each
20 questions
-
Classify suture materials (absorbable or non-absorbable, natural or synthetic, monofilament or braided) and relate the choice to the tissue
17 questions
-
Describe needle types, common suturing techniques, the use of drains and the principles of wound closure
19 questions
Management of the patient with jaundice
-
Classify jaundice as prehepatic, hepatic or posthepatic and explain bilirubin metabolism
17 questions
-
Elicit the history and signs that distinguish surgical (obstructive) jaundice from medical causes
6 questions
-
Interpret liver function tests, ultrasound and further imaging (CT, MRCP, ERCP) in obstructive jaundice
19 questions
-
Outline the management of obstructive jaundice, including correction of coagulopathy, renal protection, biliary drainage and the treatment of gallstone and periampullary disease
11 questions
Management of the patient with dysphagia
-
List the causes of dysphagia, distinguishing oropharyngeal from oesophageal and mechanical from motility disorders
17 questions
-
Outline investigation: upper gastrointestinal endoscopy, contrast swallow and manometry
12 questions
-
Outline the management of oesophageal carcinoma, achalasia and corrosive stricture, including palliation of dysphagia
7 questions
Dyspepsia
-
Describe the causes of dyspepsia and the alarm features that require urgent endoscopy
15 questions
-
Outline investigation, including testing for Helicobacter pylori and upper gastrointestinal endoscopy
12 questions
-
Outline initial management and the indications for surgical referral
9 questions
Presentation and management of peptic ulcer disease
-
Describe the pathophysiology of peptic ulceration and the roles of Helicobacter pylori and NSAIDs
14 questions
-
Describe the clinical presentation and investigation of peptic ulcer disease
15 questions
-
Recognise and manage the complications: perforation, bleeding and gastric outlet obstruction
24 questions
-
Outline the operations used for complicated peptic ulcer disease and their sequelae
10 questions
Management of the patient with haematemesis
-
List the causes of upper gastrointestinal bleeding and their relative frequency
17 questions
-
Assess severity and resuscitate the bleeding patient, including transfusion decisions
6 questions
-
Outline the role and timing of endoscopy and endoscopic haemostasis
12 questions
-
Outline the management of variceal bleeding and the indications for surgery or radiological intervention
16 questions
Management of the patient with acute abdomen
-
Describe the pathophysiology of visceral and parietal pain and the patterns of referred pain
18 questions
-
Generate a differential diagnosis for acute abdominal pain by site, age and sex, including gynaecological and medical causes
8 questions
-
Select and interpret investigations: blood tests, erect chest and abdominal radiographs, ultrasound, CT and diagnostic laparoscopy
15 questions
-
Outline resuscitation and the criteria for laparotomy, with reference to appendicitis, perforated viscus and generalised peritonitis
13 questions
Management of the patient with intestinal obstruction
-
Distinguish mechanical obstruction from paralytic ileus, and small bowel from large bowel obstruction
13 questions
-
List the causes of intestinal obstruction in Ghana, including adhesions, hernia, volvulus, tuberculosis and malignancy
13 questions
-
Recognise strangulation and closed-loop obstruction
23 questions
-
Outline resuscitation, nasogastric decompression and the indications for and principles of operative management
18 questions
Presentation and management of large bowel tumours
-
Describe the risk factors, the adenoma-carcinoma sequence and the pathology of colorectal cancer
17 questions
-
Recognise the presentations of colorectal cancer by site, including obstruction, bleeding and anaemia
11 questions
-
Outline investigation and staging: colonoscopy with biopsy, CT, MRI for rectal cancer and tumour markers
14 questions
-
Outline the surgical resections appropriate to each site, the role of adjuvant therapy, stomas and palliation
16 questions
Management of the patient with bleeding per rectum
-
List the causes of rectal bleeding according to age and the character of the bleeding
9 questions
-
Interpret the findings of anorectal examination and proctoscopy
15 questions
-
Outline investigation, including colonoscopy, and the management of massive lower gastrointestinal bleeding
10 questions
-
Outline the management of haemorrhoids and other benign anorectal causes of bleeding
10 questions
Management of the patient with painful anal condition
-
Describe the anatomy of the anal canal and its relevance to anal disease
10 questions
-
Distinguish anal fissure, perianal abscess, fistula-in-ano, thrombosed haemorrhoids and pilonidal disease
22 questions
-
Outline the management of each condition, including drainage of abscess and the principles of fistula surgery
4 questions
Management of the patient with goitre
-
Classify goitre and describe the surgical anatomy of the thyroid gland
11 questions
-
Assess a patient with goitre, including thyroid status and features suggesting malignancy or compression
20 questions
-
Interpret thyroid function tests, ultrasound and fine needle aspiration cytology
15 questions
-
Outline management, including the indications for thyroidectomy, preparation of the thyrotoxic patient and the complications of thyroidectomy
4 questions
Management of the patient with breast lump and nipple discharge
-
Describe the benign and malignant causes of a breast lump and of nipple discharge
20 questions
-
Apply triple assessment: clinical examination, imaging and pathology
18 questions
-
Recognise the features and staging of breast cancer and discuss the late presentation commonly seen in Ghana
14 questions
-
Outline the treatment of breast cancer (surgery, radiotherapy, systemic and hormonal therapy) and the management of benign breast disease
16 questions
Management of the patient with cervical lymph node enlargement
-
Describe the lymphatic drainage of the head and neck and its value in localising disease
16 questions
-
Generate a differential diagnosis for cervical lymphadenopathy, including tuberculosis, HIV, lymphoma and metastatic carcinoma
20 questions
-
Outline investigation, including fine needle aspiration cytology and excision biopsy, and explain when excision biopsy is preferred
14 questions
Management of the patient with enlarged spleen
-
List the surgical and medical causes of splenomegaly seen in Ghana
25 questions
-
Distinguish an enlarged spleen from other left upper quadrant masses
10 questions
-
Outline the indications for splenectomy and the prevention and management of overwhelming post-splenectomy infection
10 questions
Management of the patient with bladder outflow obstruction
-
Describe the causes of bladder outflow obstruction, principally benign prostatic hyperplasia and urethral stricture
28 questions
-
Assess the patient using symptom scoring and examination including digital rectal examination, and distinguish acute from chronic retention
19 questions
-
Interpret investigations: urinalysis, renal function, PSA, ultrasound with post-void residual volume and uroflowmetry
15 questions
-
Outline management: catheterisation, medical therapy and surgical options such as TURP, with their complications
13 questions
Management of the patient with renal colic
-
Describe the formation, types and risk factors of urinary tract stones
17 questions
-
Recognise ureteric colic and distinguish it from other causes of loin pain
13 questions
-
Outline investigation, including urinalysis, ultrasound and non-contrast CT
17 questions
-
Outline management: analgesia, medical expulsive therapy, urgent decompression of an obstructed infected system, ESWL, ureteroscopy and prevention of recurrence
11 questions
Management of the patient with haematuria and renal mass
-
Classify haematuria and list its urological and medical causes
20 questions
-
Outline the evaluation of haematuria, including imaging and cystoscopy
18 questions
-
Describe the presentation and investigation of renal cell carcinoma, Wilms tumour and bladder cancer, including the association of squamous bladder cancer with schistosomiasis
11 questions
-
Outline the principles of management of urological tumours
4 questions
Management of the patient with urinary tract injury
-
Describe the mechanisms and sites of injury to the kidney, ureter, bladder and urethra
14 questions
-
Recognise the features of urethral and bladder injury and explain why urethral catheterisation may be contraindicated
15 questions
-
Outline investigation (urethrography, cystography, CT urography) and the principles of management
9 questions
Diagnosis of inguinoscrotal swelling
-
Describe the anatomy of the inguinal canal and scrotum relevant to inguinoscrotal swellings
17 questions
-
Differentiate hernia, hydrocele, varicocele, epididymal cyst, testicular tumour and epididymo-orchitis on clinical examination
15 questions
-
Recognise testicular torsion and strangulated hernia as surgical emergencies
19 questions
-
Outline the management of inguinal hernia, hydrocele and testicular tumour
15 questions
Management of the patient with multiple trauma
-
Apply the primary survey (ABCDE) with cervical spine control and identify immediately life-threatening injuries
28 questions
-
Outline resuscitation, including haemorrhage control, use of fluids and blood products, and damage control principles
25 questions
-
Describe the secondary survey, its adjuncts (FAST, radiographs, CT) and the principles of triage and transfer
16 questions
-
Outline the assessment and initial management of abdominal and pelvic trauma, including the indications for laparotomy
11 questions
Management of the patient with head injury
-
Classify head injury and explain primary and secondary brain injury, raised intracranial pressure and cerebral perfusion
5 questions
-
Assess the patient using the Glasgow Coma Scale and pupillary findings, and recognise herniation
12 questions
-
State the indications for CT and for neurosurgical referral, and recognise extradural, subdural and intracerebral haematoma
15 questions
-
Outline management: airway protection, prevention of secondary injury and operative options
12 questions
Management of the patient with chest injury
-
List the immediately life-threatening chest injuries
5 questions
-
Recognise and manage tension pneumothorax, open pneumothorax, massive haemothorax, flail chest and cardiac tamponade
19 questions
-
Interpret chest radiographs in thoracic trauma
19 questions
-
Describe chest drain insertion and the indications for thoracotomy
17 questions
Management of burns
-
Classify burns by depth and mechanism and explain the pathophysiology of burn shock
23 questions
-
Estimate burn surface area and calculate fluid resuscitation
15 questions
-
Recognise inhalational injury and the other indications for referral to a burns unit
9 questions
-
Outline wound care, nutrition, infection control, escharotomy and the late complications of burns
16 questions
Presentation and management of spinal cord compression
-
List the causes of spinal cord compression, including trauma, spinal tuberculosis, tumour and disc prolapse
13 questions
-
Recognise the clinical features, including a sensory level, bladder involvement and cauda equina syndrome
5 questions
-
Outline urgent investigation with MRI and the assessment of spinal stability
14 questions
-
Outline emergency management and the indications for surgical decompression
12 questions
Presentation and management of intracranial tumours and infections
-
Describe the common intracranial tumours and their presentations, including raised intracranial pressure, seizures and focal deficits
19 questions
-
Describe brain abscess and subdural empyema and their sources of infection
16 questions
-
Outline investigation and the principles of surgical management
11 questions
Presentation and management of infections of the CNS
-
Describe the routes of spread and the surgical causes of CNS infection, including open skull fracture, sinus and ear disease and shunt infection
14 questions
-
Distinguish meningitis, encephalitis and focal suppurative lesions clinically
16 questions
-
Outline investigation, antimicrobial therapy and the indications for surgical drainage
12 questions
Presentation and management of ischaemia of the leg
-
Describe the pathophysiology and risk factors of acute and chronic limb ischaemia
18 questions
-
Distinguish acute from chronic ischaemia and grade chronic disease from claudication to tissue loss
25 questions
-
Outline assessment: peripheral pulses, ankle-brachial pressure index, duplex ultrasound and angiography
17 questions
-
Outline management: risk factor control, revascularisation, and the indications for and levels of amputation
22 questions
Presentation and management of swollen leg
-
Generate a differential diagnosis for unilateral and bilateral leg swelling, including deep vein thrombosis, cellulitis, lymphoedema and filariasis
21 questions
-
Outline investigation, including Doppler ultrasound and D-dimer
17 questions
-
Outline the management of deep vein thrombosis and of chronic lymphoedema
13 questions
Management of the patient with leg ulceration
-
Compare venous, arterial, neuropathic and other ulcers, including Buruli ulcer, sickle cell ulcers and malignant ulcers, by site and appearance
19 questions
-
Outline investigation of a leg ulcer, including assessment of the arterial supply before compression is applied
18 questions
-
Outline management, including compression therapy, wound care and treatment of the underlying cause
4 questions
Common problems in plastic surgery
-
Describe wound healing, the factors that impair it and the reconstructive ladder
20 questions
-
Describe skin grafts and flaps, their indications and their complications
14 questions
-
Outline the management of hypertrophic and keloid scars, contractures and common congenital problems such as cleft lip and palate
6 questions
Presentation and management of skin tumour
-
Describe the risk factors and pathology of squamous cell carcinoma, basal cell carcinoma and melanoma, including their occurrence in albinism and in chronic ulcers
15 questions
-
Recognise the clinical features that suggest malignancy in a skin lesion
14 questions
-
Outline biopsy technique, excision margins and the management of regional lymph nodes
14 questions
Surgical problems in infancy
-
Recognise the neonatal surgical emergencies: intestinal atresia, malrotation with volvulus, necrotising enterocolitis, anorectal malformation and diaphragmatic hernia
8 questions
-
Describe the presentation and management of infantile hypertrophic pyloric stenosis and of intussusception
9 questions
-
Describe the childhood solid tumours common in Africa, including Wilms tumour, Burkitt lymphoma and retinoblastoma
15 questions
-
Outline the principles of fluid, thermal and nutritional care in infants undergoing surgery
6 questions
X-ray (demonstration)
-
Describe a systematic approach to reading plain radiographs of the chest, abdomen and skeleton
17 questions
-
Recognise the key surgical signs: free gas under the diaphragm, dilated bowel loops with fluid levels, pneumothorax, pleural effusion and common fracture patterns
21 questions
-
State the indications for and limitations of plain radiography compared with ultrasound and CT, including radiation safety
20 questions
Anaesthesia
-
Describe the anaesthetic assessment, fluid and transfusion therapy, pain relief and monitoring of the critically ill surgical patient.
26 questions
Management of the critically ill patient
-
Recognise the critically ill surgical patient using a structured (ABCDE) assessment and early warning signs
11 questions
-
Outline the principles of organ support: airway, ventilation, circulatory and renal support
13 questions
-
Describe the criteria for intensive care admission and the principles of sepsis management
19 questions
Fluid therapy and blood transfusion
-
Describe the body fluid compartments and the composition of commonly used intravenous fluids
14 questions
-
Calculate maintenance, replacement and resuscitation fluid requirements in surgical patients
14 questions
-
State the indications for blood and component transfusion and describe pre-transfusion safety checks
19 questions
-
Recognise and manage transfusion reactions and the complications of massive transfusion
20 questions
General and local anaesthesia and pain relief
-
Describe the components of general anaesthesia (induction, maintenance, muscle relaxation and reversal) and the agents used
24 questions
-
Describe local anaesthetic agents, maximum safe doses and techniques, and the recognition and management of toxicity
19 questions
-
Compare regional techniques, including spinal and epidural anaesthesia, with their indications and complications
8 questions
-
Outline postoperative analgesia using the analgesic ladder, multimodal analgesia and safe opioid prescribing
8 questions
Clinical assessment and perioperative medical problems
-
Conduct a preanaesthetic assessment, including airway assessment and ASA grading
22 questions
-
Describe the perioperative management of hypertension, ischaemic heart disease, asthma, diabetes and anaemia
22 questions
-
Recognise and outline the management of common postoperative anaesthetic problems: hypoxia, hypotension, nausea and vomiting and delayed recovery
19 questions
Emergency cardiac drugs
-
State the indications, doses and routes of adrenaline, atropine, amiodarone and vasopressor agents in cardiac emergencies
10 questions
-
Explain their mechanisms of action and adverse effects
16 questions
-
Apply these drugs within the cardiac arrest and peri-arrest algorithms
14 questions
Monitoring in the ICU
-
Describe routine monitoring: ECG, pulse oximetry, capnography, non-invasive and invasive blood pressure and urine output
6 questions
-
Interpret monitoring data to recognise the deteriorating patient
13 questions
-
Describe the principles and complications of central venous pressure monitoring and of mechanical ventilation
18 questions