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Study guide 2019-2020

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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
General Surgery
Course Code: SURG551
Credit Hours: 10 hours
Student & Tutor Guide
2019-2020
COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Table of Content
General information
Course Tutors
Objectives of the course
Course Content
Clinical Attachment
Weekly Schedule
Assessment
Learning Resources
Important Remarks
Appendix
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
General Information
Welcome to the new academic year !!. Surgery-2 course is devoted to general
surgery (breast / endocrine, upper gastrointestinal, hepato-pancreatobiliary,
colorectal, trauma and acute surgery) and some subspecialties including burns and
plastics, urology, vascular, neurosurgery, cardiothoracic surgery and
ear/nose/throat surgery. I encourage all students to get involved and maximize
the exposure during clinical rotation and to see as much as they can in surgical
wards.
We hope that you will find this attachment useful and enjoyable. Supporting you
is central to our mission at college of medicine . We are here to guide you as you
become the best version of yourself.
Subject Title
Surgery Course
Block Code & Number
SURG-551
Credit Hour
10 hours
Subject Dates
Patch 1: 1/9/2019
Patch 2: 24/11/2019
Subject Duration
11 weeks
Subject Chair/ Co-chair
Reem Alharbi/Huda Magrabi
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Course Tutors
Name
Contact Info.
Course
Chair
Reem Alharbi
[email protected]
Course CO- Chair
Huda Mugrabi
[email protected]
Shaikha alrajeebah
SARA aldobiban
Prof. Nadeem
Areej abanomy
Ali M. Ahmad
Haifa Malaekah
Mohamad abdulaaly
Nawaf Alotaibi
Sara Almohaisen
Sari Rabah
Saeed Alshalawi
Daniah Abuali
Mohamed Alshehri
Tawheed Ahmad
Nadeem Rehmani
[email protected]
[email protected]
Faisal Alotaibi
[email protected]
Abdullah alsulimani
Khalid bakarman
Rakan Nazer
[email protected]
[email protected]
[email protected]
PNU
KAAUH
Guest
Tutors
SURG 551 Course Student & Tutor Guide 2019-2020
[email protected]
[email protected]
[email protected] kaauh.edu.sa
[email protected] kaauh.edu.sa
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Course Objectives
GENERAL OBJECTIVES
By the end of this course student should be able to:
o
SPECIFIC OBJECTIVES:
I- BASIC AND CLINICAL KNOWLEDGE:
o Acquire knowledge & understanding of common diseases related to surgery in term of etiology,
pathogenesis, clinical diagnosis, differential diagnosis, needed investigations, and management
plan
II. CLINICAL SKILLS:
o
o
o
o
Take medical history from patients and simulated patients, interpret the findings in history and
decide on body systems to be examined.
Conduct a detailed clinical examination, elicit clinical signs, interpret findings, and link clinical
findings with history findings.
Weigh evidence from clinical examination and medical history in refining their hypotheses,
generating a differential diagnosis, and deciding on laboratory and other investigations needed.
Practice clinical procedures and techniques recommended for their learning at this stage.
III. ATTITUDES AND RESPONSIBILITIES:
o Demonstrate professional attitude that fosters patient-centered care, and enforces the
quality of health care recommended by the college standards.
o Communicate effectively with patients, members of their family, and with his/her
colleagues and supervisors
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DEPARTMENT OF CLINICAL SCIENCES
Course Content
A. Lectures
This includes lectures, which will be prepared and presented by tutors and mostly will be:
In the First two weeks of the rotation.
Basic lectures aims at giving an overall framework of key principles related to a particular topic.
They are not meant to give full details about a topic. Therefore, students should read textbooks
and other resources recommended in order to fully understand a topic. A lecture might also aims
at explaining difficult concepts, enabling students to focus on important principles, and
encouraging them to further explore more details. Each lecture has its educational objectives and
students should be clear about the objectives of the lecture and how to use knowledge learnt in
clinical practice.
Topic List
1
Learning Objectives
Contact
Hours
General outlines for the course
Introduction to Surgery
2
Surgical Infection and antibiotics
3
Shock
1- Definitions ( SIRS, sepsis, severe sepsis, septic shock ) , Differentiate between SIRS, sepsis, severe sepsis
and septic shock.
2- Pathogenesis
3- Clinical features of infection , investigations & classification of surgical site infection(SSI) ( superficial ,
deep & organ) (general)
4- Common pathogens
5- Common infections
6- Antibiotics use :
Therapeutic
Prophylactic
1-Definition of shock
2-Causes of shock
3-Pathophysiology of shock
4-Effects on individual organ systems
5-Principles of management
6-Hemorrhage
4
Blood Transfusion
And reactions
1.Explain the methods used to collect blood, process and store it’s various components.
2.Explain the principles of red cell and blood component transfusion and list the indications and
contraindications for red cell, platelet, fresh frozen plasma, and specific factor concentrate transfusions
Basic
3.Discuss the complications, diagnosis, and management of blood and component transfusion.
5
I.V fluid& Acid Base disorders
1-To appreciate the critical role of fluid balance in surgery
2- To understand acid—base balance in relation to surgery and water and electrolyte abnormalities
6
post op assessment& complication of surgery
7
Pre-op assessment & management
1.Identifying co-existing medical conditions and how to optimise the patient’s health, while appreciating the
urgency of their operation.
2. Discuss improvable factors to help support patients to be as fit as possible (including smoking cessation,
reducing alcohol, better nutrition and taking regular moderate physical exercise).
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ICU monitoring & management of critically
sick patient
3. Identify patients with a high risk of perioperative complications and identifying their appropriate level of
postoperative care.
4. Describe the process of discharge planning.
5. Identify the variables that provide prognostic information for all patients planning to undergo surgery.
For the following post-operative complications:
•atelectasis . deep vein thrombosis (DVT) •fever •internal hemorrhage •pneumonia •pressure ulcer •pulmonary
embolus(PE) •sepsis •urinary tract infection (UTI) •wound infection/dehiscence
1.Understand the predisposing factors
2.Recognize the clinical manifestations through the appropriate history and physical exam
3.Develop a differential diagnosis
4.Order and interpret the results of the appropriate diagnostics (including laboratory, diagnostic and
radiological studies/findings)
5.Recommend and/or initiate appropriate management
6.Identify strategies for prevention when applicable
9
Nutritional support
1.Identify patients in need of nutritional optimisation, especially pertaining to BMI, serum albumin, frailty or
triceps skin fold thickness.
2. List the physiological effects of protein–calorie malnutrition.
3. Identify the different types of nutritional support – oral, nasogastric, gastro/jejunostomy and parenteral.
4. Describe what total parenteral nutrition (TPN) entails, its associated risks, and the additional and particular
parameters of care for these patients.
10
1. Describe the symptoms, signs, and differential diagnosis for patients presenting with an acute abdomen.
Surgical Emergencies
2. Discuss the investigations and management of patients with acute abdominal pain (including conditions such
as peritonitis, obstruction and pancreatitis).
3. Describe the pre and postoperative management of an acutely unwell patient who requires emergency
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surgery.
4. Discuss the difficulties with fluid management and electrolyte derangements, including oliguria and acute
kidney injury.
11
1
ray-Surgical X
Presentation & Management of Swollen leg
including varicose veins & atherosclerosis
Identification of common surgical conditions including x-ray, CT
Chronic Limb Ischaemia:
1. Describe the symptoms and signs of chronic limb ischaemia.
2. Describe the pathogenesis of peripheral vascular disease.
3. List risk factors for the development of peripheral vascular disease and
describe how each of these can be looked for and controlled.
4. Describe the investigations that should be performed to determine the
presence and severity of peripheral vascular disease.
5. Discuss with a patient on improving symptoms, slowing progression and
preventing complications of peripheral vascular disease.
2
6. List indications for percutaneous transluminal angioplasty and arterial reconstruction surgery.
7. Describe the percutaneous transluminal angioplasty and arterial
reconstruction surgery to a patient, including risk of complications.
8. Discuss indications for limb amputation.
Acute Limb Ischaemia:
1. Describe the symptoms and signs .
2. Discuss mechanisms leading to acute limb ischaemia.
3. Explain the nature and timing of pathological changes that will occur in
an acutely ischaemic limb if the ischaemia is not relieved.
Presentation & Management of Ischemic leg & ulceration
4. Describe the emergency investigation of a patient with acute limb ischaemia.
5. Discuss the options available for emergency management of acute limb ischaemia
including anticoagulation, thrombolysis, angioplasty and embolectomy.
Compartment Syndrome:
1. Explain symptoms, signs, pathogenesis and management.
Venous disease:
Vascular
To understand the basic venous anatomy of the lower limb.
To understand the basic pathophysiology of the varicose veins and venous insufficiency.
To understand the basic principles of diagnosis & treatment of varicose veins.
Lymphatic disease:
1.recognize the physical signs for each stage of lymphoedema
2. stage lymphoedema using these physical signs
3.describe the functions of the lymphatic system
4.list the consequences of filariasis for the lymphatic vessels
5. lymphoedema management for each stage
Cardiac
1
1-List risk factors and common clinical symptoms in patient with ischemic heart disease
2-List treatment options for patient with ischemic heart disease
Assessment & Management of patients with
Coronary artery diseases
Thoracic
1
1-Describe the clinical manifestation, anatomy , treatment of thoracic aortic aneurysms
2-Discuss the diagnostic modalities available to investigate chest lesions (e.g., pulmonary mass, chest wall
tumor, pleural disease)
Management of patients of lung lesions+ chest
truma
3-Discuss the evaluation and differential diagnosis of hemoptysis
4-Create an algorithm to evaluate a solitary lung nodule
5-Describe the common causes of pleural effusion and discuss the distinctions between exudate and transudate.
6-Discuss the etiology and management of lung abscess
1.Explain the terms dysphagia and dyspepsia.
2. Identify the different causes of dysphagia, including strictures,
1
GI + general surgery
3-Describe indication for surgical intervention in patient with IHD
4-Complication of MI
5-Clinical indication for aortic,tricuspid and mitral valve replacement
Presentation Management of Dysphagia
(esophagus)
malignancy, achalasia, and neurological causes.
3. Explain ‘red flag signs’ and the role of blood tests, endoscopy and
contrast studies in the assessment of dysphagia.
4. Explain the presentation of and risk factors for oesophageal cancer.
5. List the medical and surgical treatment of oesophageal cancer including palliative care.
6.Describe the etiology, pathogenesis and pathology of Barrett’s oesophagus.
7. Describe the conservative, medical and surgical treatment of GERD.
.Anatomy, Presentations ,Definitions and Managements of:
2
. Inguinal and Femoral Hernias• Miscellaneous Hernias• Prosthetic Mesh Infections - Management• Umbilical
and Epigastric Hernias• Ventral Hernia.
Hernias
Other rare abdominal hernia.
Describe the anatomic differences between indirect and direct hernias.
Discuss the relative frequency of indirect, direct, and femoral hernias by age and gender.
Explain the clinical conditions that may predispose development of inguinal hernia
Define and discuss the clinical significance of incarcerated, strangulated, reducible, and Richter’s hernias.
.State the principles of surgical treatment in a multi-injured patient.
3
.Assess priorities during all phases of management following ATLS principles.
. Know the importance of re-assessment of the patient with regards to earlier interventions.
Trauma
SURG 551 Course Student & Tutor Guide 2019-2020
Explain primary and secondary survey.
. Explain the different mechanisms of trauma injury (blunt v penetrating v crush v blast).
. Explain the importance of the ATLS strategy and systematic approach: rapid primary survey, concurrent
resuscitation, secondary survey, continued re-evaluation and monitoring, investigation and definitive care.
Explain the role of radiological investigations (eg CT scanning) and interventions.
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Explain the role of investigation and treatment is dependent on the haemodynamic status of the patient.
1- To understand the anatomy of the anus and anal canal and their relationship to surgical disease and its
treatment
4
Anal Pain & Discharge
2- To understand the pathology, clinical presentation, investigation, differential diagnosis and treatment of
diseases which affect the anus and anal canal
3. Management of emergency anorectal conditions .
5
RUQ & RLQ Abd Pain & Mass
(liver+ pancrease)
(appendex)
1-To understand the management and features of liver nodules , infections, cirrhosis and tumors
2-State the essential pathology , sign, symptoms, investigation ,diagnosis and management of: appendicitis,
3-To understand the anatomy and physiology of the pancreas
4-To be familiar with investigation at the pancreas
5- To be aware of the rarer conditions of the pancreas
6- To be capable of assessing and managing a patient with acute pancreatitis and complication of pancreatitis.
7- To understand pancreatic cancer - its diagnosis, treatment and palliation
6
7
. Describe the blood supply to the lower gastrointestinal tract.
LUQ Abd Pain & Mass (spleen )
2. List potential causes of change in bowel habit.
LLQ Abd Pain & Mass( large bowel disease)
3. List potential causes of rectal bleeding.
4. Summaries the etiology ,pathology of the common causes of change in bowel habit, including: irritable
bowel syndrome, coeliac disease, colorectal cancer, inflammatory bowel disease, thyroid disease, diverticular
disease and bowel obstruction.
5. Explain the etiology, pathology of the common causes of rectal bleeding including: colorectal cancer,
diverticular disease, hemorrhoids, anal fissures and inflammatory bowel disease.
6. List the common causes of diarrhea and constipation.
7. Recognize the signs and symptoms for colorectal cancer and its pathological development.
8. Explain the management for rectal bleeding, including relevant investigations and the indications for surgical
intervention.
8
Central Abdominal pain & Mass (small bowel )
9
Epigastric Pain and Mass (stomach and
duodenum) + obesity
9.list common indication of splenectomy and possible complication
1- To understand the gross and microscopic anatomy and pathophysiology of the stomach in relation to disease
2- To be able to decide on the most appropriate techniques to use in the investigation of patients with
complaints relating to the stomach and duodenum
3- To understand the critical importance of gastritis and Helicobacter pylori in upper gastrointestinal disease.
4- To be able to investigate and treat peptic ulcer disease and its complications
5- To be able to recognize the presentation of gastric cancer and understand the principles involved in its
treatment
6- To know about the causes of duodenal obstruction and the presentation of duodenal tumors
List the causes of jaundice.
10
Obstructive jaundice
3. Describe the presentation of a patient with obstructive jaundice.
4. Explain the investigation and management of obstructive jaundice.
5- Know the different type of gallstones
6. Compare and contrast the (1) clinical presentation, (2) laboratory and radiologic findings, and (3)
management of a patient with chronic cholecystitis (biliary colic) and a patient with acute cholecystitis., acute
cholangitis ,
11
Hematemesis (Upper GI Bleeding)
12
Bleeding Per Rectum (Lower GI Bleeding)
Presentation, investigation and management of upper and lower GI bleeding
(approach)
1 Describe the aetiology and pathology of common benign and malignant lumps occurring in the neck,
including those arising from the salivary/thyroid/parathyroid glands and lymph nodes.
1
Common neck swellings
2. Recognise high-risk symptoms, eg dysphagia, voice change and throat/mouth/neck pain.
3 Describe investigations including ultrasound, CT, MRI, nasoendoscopy, video contrast swallow and tissue
biopsy.
4 Explain different treatment modalities, including antibiotics, surgery and chemotherapy/radiotherapy.
1.Describe the clinical features of Cushing's syndrome and discuss how lesions in the pituitary, adrenal cortex,
and extraadrenal sites are distinguished diagnostically
2
Endocrine
2.Discuss the medical and surgical management of Cushing's syndrome in patients with an adrenal adenoma,
with a pituitary adenoma causing adrenal hyperplasia, and with an adrenocorticotropic hormone (ACTH)producing neoplasm.
Adrenal gland diseases and tumor
3. Describe the pathology, clinical features, laboratory findings, workup, and management of a patient with
primary aldosteronism.
4. Discuss pheochromocytoma, including its presentation, signs and symptoms, diagnostic workup, and
treatment.
5. Discuss adrenal cortical carcinoma, including associated signs and symptoms, appropriate diagnostic
workup, and management.
6. Discuss the management and evaluation of an incidentally discovered adrenal mass.
7. Discuss the causes of adrenal insufficiency in the surgical setting as well as the associated clinical and
laboratory findings.
Multiple Endocrine Neoplasia Syndromes
Describe the multiple endocrine neoplasia syndromes and their surgical treatments
3
Management of thyroid & PTH tumors
1. Discuss the evaluation and differential diagnosis of a patient with a thyroid nodule.
2. List the different types of carcinoma of the thyroid gland and their cell type of origin; discuss the appropriate
therapeutic strategy for each
3. Understand the major risk factors for carcinoma of the thyroid gland and the prognostic variables that dictate
therapy
4. Describe the symptoms of a patient with hyperthyroidism; discuss the differential diagnosis and treatment
options.
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Parathyroid Glands :
1. Understand the role of the parathyroid glands in the physiology of calcium homeostasis.
2. List the causes, symptoms, and signs of hypercalcemia.
3. Know the difference between primary, secondary, and tertiary hyperparathyroidism
4.Discuss the evaluation and differential diagnosis of a patient with hypercalcemia
5. Understand the management of acute and severe hypercalcemia
6. Describe the indications for surgery for hyperparathyroidism
7. Describe the complications of parathyroid surgery
1
1. Categorize the risk factors for breast cancer into major and minor factors.
2. Provide the guidelines for routine screening mammography.
3. Describe the diagnostic workup and management for common benign breast conditions, nipple discharge,
and breast abscess.
Breast
Management of patient with breast lump and
Nipple discharge
4.List the diagnostic modalities and describe their sequence in the workup of a patient with a breast mass or
nipple discharge.
5. Describe the preoperative evaluation for a patient with breast cancer.
6. Provide the differential diagnosis of a breast patient with breast cancer. lump in a woman in her 20s and in a
woman in her 60s.
7. Describe how ductal cancer in situ differs Supply from invasive breast cancer. Describe its role the as a risk
factor for invasive cancer.
8. Explain the rationale for breast conservation treatment as the preferred therapeutic option for most stage I
and stage II breast cancers.
9. Describe the rationale for adjuvant therapy radiation therapy, and hormonal therapy in the treatment of breast
cancer
10. Describe the expected survival and local recurrence rates after treatment for early breast cancer
1
Urology
2
3
Presentation & Management of patients with
Hematuria & renal masses
Lower Urinary Tract Symptoms (LUTS) and
Scrotal Swellings
Presentation & Management of Patients with
Renal Colic
4
Presentation & Management of Common
Problems in pediatric urology
1. Describe the symptoms and signs that can be used to distinguish between the different causes of loin pain.
2. Describe the role of a CT KUB in identifying radio-opaque renal stones,
and the role of ultrasound in identifying hydronephrosis.
3. Discuss the role of conservative management and interventions,
including lithotripsy, in managing renal calculi.
5. List the risk factors, aetiology, treatment and complications of acute pyelonephritis.
6. Explain the diagnosis, assessment and treatment of tumours arising within the urinary tract.
1. Explain the anatomy of the male urinary tract and the physiology of voiding. 2. Classify the causes of urinary
outflow obstruction by the site of obstruction
3. Distinguish between the symptoms of upper and lower urinary tract obstruction.
4. Describe the range of laboratory tests and imaging techniques used in the investigation of patients with
urinary outflow obstruction, in particular the role of the PSA test.
5. Explain the pathology of the following common causes of urinary tract
obstruction, and their medical or surgical management
6. State the complications of untreated urinary tract obstruction.
7. Define and classify haematuria, and be able to describe the common causes of it
8. Explain the pathology of common causes of haematuria,, their medical and surgical management
1
Diagnose the different causes of scrotal lumps/swelling/pain including: varicocele,hydrocele, epididymal cysts,
epididymo-orchitis, testicular torsion, hernias and cancer.
. Recognise testicular torsion as a urological emergency and understand its management
Pediatric
Common pediatric surgery conditions
Neurosurgery
1
2
Explain the pathophysiology, clinical presentation, and management of:
-
Congenital diaphragmatic hernia
Esophageal atresia and tracheoesophageal fistula
Intestinal obstruction
-
Anorectal malformation
Necrotizing enterocolitis
Infant with jaundice particularly biliary atresia
-
Omphalocele and gastroschisis
. List the symptoms and signs of raised intracranial pressure (eg vomiting).
. Describe the pathophysiology of raised intracranial pressure
Presentation Management of Intracranial
tumors & infections
. Explain the assessment of a patient with possible raised intracranial pressure, intracranial blood clot or mass
lesion.
Presentation & Management of spinal cord
lesions and head injuries
1.Describe the following spinal cord syndromes: acute transverse myelopathy, Brown- Séquard syndrome,
anterior cord syndrome and central cord syndrome. 2.List the important steps in the evaluation and
management of acute spinal cord injury. Consider bodily injury, spinal instability, and spinal cord damage.
. Describe monitoring and interventions that may be possible, including decompressive craniotomy.
. Summarise sub arachnoid haemorrhage
3.Describe the indications for external immobilization and for internal decompression and fusion.
List common intramedullary ,intradural ,exteramedullary and exteradural tumours and compare their mode of
presenation.
1
Plastic
Inguinal:
1. Assess and initiate management of a child presenting with groin pathology (including undescended testis,
hernia, hydrocele and painful swellings of the genitalia), .
2
Presentation & Management of Common
Problems in plastic surgery (wound+ common
congenital )
Presentation & Management of Skin lesions(
cancer+ common lesion)
Discuss the different types of skin grafts and flaps.
Differentiate hypertrophic scar and keloid formation from normal wound healing
Describe the evaluation, diagnosis, and treatment of common tumors of the hand.
Describe the development of prepalatal and palatal structures and their relation to cleft lips and cleft palates
Describe the evaluation, diagnosis of congenital defects of the hand (syndactyly, polydactyly)
Congenital head and neck anomalies( brachial cleft cysts, thyroglossal duct cyst, congenital ear deformaties)
Describe the clinical presentation and indications for treatment of benign skin lesions, including nevi ,keratosis,
hemangiomas, cysts, and lipomas.
Describe the clinical presentation and indications for treatment of skin cancer
Differentiate between SCC,BCC.
1. List the classification of burns by depth of injury, and indicate the anatomic and patho- physiologic
differences between these injuries
3
Presentation & Management of Burn Patient
SURG 551 Course Student & Tutor Guide 2019-2020
2. List the initial steps in the acute care of the patient with a burn injury
3. List three types of inhalation injury, and describe their pathophysiology
4. List the general indications for referral of a patient to a burn center.
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5. Define burn shock, and outline its treatment .
6. List the advantages and disadvantages of fascial and tangential excision of burn wounds.
7. In addition to fluid resuscitation and surgery list three other general areas of care that are important in the
management of patients with burns
B. Tutorials :
These sessions will be undertaken in the clinical skills lab. Students will work on specific
tasks related to the core and course specific procedures in the curriculum.
Each student must possess the required skill and gain the required competency to preform
proper technique for the following procedures:
Topic List
Task based learning( TBL): How to insert folly’s catheter
Task based learning( TBL): How to insert NGT
Task based learning( TBL): draping preparation
Task based learning( TBL): basic suturing technique
Drains, Tubes and Catheters
surgical instrument and suture material
C. Student presentations:
Second week of Block
In these presentations students will work in preparing a presentation about a certain topic in
surgery and will be expected to present to the class. You will be provided with a presentation
template to ensure that all the objectives have been met. The presentation will be 10-15
minutes. You will be marked accordingly.
Presentations will based on the curriculum and enable student to consider in their discussion
the following:
• Identification of presenting complaints, possible causes and contributing factors.
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COLLEGE OF MEDICINE
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• Generation adequate medical history.
• Interpretation of history findings and clinical signs and the use
of new findings in making differential diagnosis
• Identification of investigations needed for making a final diagnosis and discussion on how
the results of these investigations can help them.
• Identification of management goals and generation of a management plan.
• Complications
• Discussion of questions raised by the tutor and the students.
D. Long cases :
During the clinical rotation cases will be required to be written up.
The students will use these cases to build on the clinical hospital experience and practice of
clinical and writing skills. Please submit the case at the end of each week (Saturday) of the
rotation to the assigned Tutor for correction. Late submissions will not be graded.
- This is a student-based activity and each student must do her own case and not copy from
each other, any copying will result in a zero in the log book
- The following format of the cases should be clearly followed:
- Student will choose a cases from their clinical training:
2 general surgery cases and 1 cases from sub-specialty week
▪ Student will do initial clerking:
▪ Full history
▪ Complete physical examination
▪ Initial admission investigations
▪ Case summary
▪ Problem list
▪ Student will do daily follow up in the SOAP format should be used as follows:
▪ S (Subjective): Changes in the patient status, in the patient’s or his guardian’s
words.
▪ O (Objective): Vital signs, examination of concerned system(s), and new investigations
results.
▪ A (Assessment): Your interpretations and evaluation of the patient condition based on the
subjective and objective data.
▪ P (Plan): Your decisions based on the assessment (e.g. order a new investigation, add or
stop a medication).
• Topic review:
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Student is expected to write a concise, focused review of the
topic of the disease process of
each case taken should include:
Brief Pathophysiology
Clinical presentation
Differential diagnoses
Management including non-operative approach and operative approach including surgery
description
Possible surgical complications
Accepted references for topic review should be from recommended textbooks and online
resources. COPY AND PASTE from online resources will not be accepted and marks
will be deducted.
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Clinical Attachment
The student will be distributed as 2-3 students per consultant (maximum) Each student will
spend:
o 4 weeks in general surgery
o 4 weeks in subspecialty based on availability: A week in each subspeciality
o
o
o
o
o
o
o
▪
▪
▪
▪
▪
▪
▪
Plastic surgery
Urology
Pediatric surgery
Vascular
Neurosurgery
Cardiac surgery
Thoracic surgery
Student is expected to:
Integrate with the team; participate in rounds (clinical and grand round), outpatient clinics,
operating room and patient floor work
Present cases in the morning round
Students will attempt to participate in the procedures learnt in the skill session.
These rotations are very important to achieve the course learning objectives and students should
be on time, and abide with professional code and attitude.
By the end of the clinical attachment, the students will be:
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

Able to communicate with patients, take medical history, elicit
clinical signs, and conduct clinical examination

Enabled to experience professional attitude and how to develop
effective patient-doctor relationship
Encouraged to apply knowledge learnt and develop a wide range of clinical skills and competencies
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Weekly Schedule
Surgery
Theme
Day
Time
Sunday
(1/9/2019)
8:00 – 9:00
9:00 – 10:00
10:00 –
11:00
11:00 – 12:00
Introduction
to SURG 551
Preoperative
Assessment &
Management
Post-Operative
Assessment
Management
complication
Surgical X
Rays
Monday
(2/9/2019)
Tuesday
(3/9/2019)
Surgical
Emergencies
Thursday
(5/9/2019)
Hernias
2:00-3:00
3:00 –
4:00
Skill Lab
Skill Lab
Assessment &
Management
of patients
with Coronary
artery
diseases
Presentation &
Management of
Skin lesions(
cancer+ common
lesion)
Chest
Injuries
Management
of patients of
lung lesions
Skill Lab
Presentation
Management
of Intracranial
tumors &
infections
Presentation
&
Management
of spinal cord
lesions and
head injuries
Skill Lab
Presentation &
Management of
Burn Patient
Presentation &
Management of
Common
Problems in
plastic surgery
(wound+
common
congenital )
Thyroid &
Parathyroid
Lateral Neck
Mass & other
soft Tissue
Lesion
ICU
Monitoring &
Management
of Critically ill
patients
Fluid Therapy &
electrolyte acid
base disorders
Adrenal & Other
Endocrine
Lesions
Management of
patient with
breast lump
and Nipple
discharge
Common
pediatric
surgery
conditions
Surgical
Infections
(Presentation &
Management)
SURG 551 Course Student & Tutor Guide 2019-2020
1:00 –
2:00
Presentation
Management of
Dysphagia
(esophagus)
Blood
Transfusion
& Substitutes
and
Reactions
Wednesday
(4/9/2019)
Shock
12:00 –
1:00
Nutritional
Support
Surgery Boot camp
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Surgery
Theme
Day Time
Sunday
(8/9/2019)
Monday
(9/9/2019)
8:00 – 9:00
9:00 – 10:00
Hematemesis
(Upper GI
Bleeding)
Bleeding Per
Rectum (Lower
GI Bleeding)
Presentation &
Management of
patients with
Hematuria &
renal masses
Lower Urinary
Tract Symptoms
(LUTS) and
Scrotal
Swellings
Epigastric Pain
and
Mass/obesity
(stomach and
duodenum)
Tuesday
(10/9/2019)
Wednesday
(11/9/2019)
Thursday
(12/9/2019)
Central
AbdPain &
Mass &
Distention
(small bowel II
and pancreas)
Jaundice
RUQ & RLQ
Abd Pain &
Mass
Change of
Bowel Habit
(inflammatory
bowel disease
& obstruction
10:00 –
11:00
Presentation &
Management
of Ischemic leg
& ulceration
Presentation &
Management
of Patients with
Renal Colic
Trauma
Left UQ Abd
Pain & Mass
(spleen and
small bowel
disease I)
Anal Pain &
Discharge
SURG 551 Course Student & Tutor Guide 2019-2020
11:00 – 12:00
Presentation &
Management of
Swollen leg
including varicose
veins
Presentation &
Management of
Common
Problems in
pediatric urology
Patient safety
and Invasive
procedures
LLQ Abd Pain &
Mass( large
bowel disease)
Upper& lower
GI bleeding
12:00 –
1:00
1:00 – 2:00
2:00-3:00
Student
presentation
Student
presentation
3:00 –
4:00
Student
presentation
Student
Presentation
Student
Presentation
Student
Presentation
Student
Presentation
Student
Presentation
Student
Presentation
Student
Presentation
Student
Presentation
Student
presentation
Student
Presentation
TBD
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Assessment
Remarks
Continuous Assessment 60 %

logbook cases
20
8 cases/ course


student presentations
Quiz
10
10
Once/course
6th week of the course

hospital evaluations
20
8 evaluations
Final Exam 40 %

Multiple Choice Questions
15
Date

Objective Simulated Clinical Examination
25
Date
Total
SURG 551 Course Student & Tutor Guide 2019-2020
100
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Learning Resources
Recommended textbooks:
1. Bailey & Love's Short practice of surgery
2. Principles and Practice of Surgery, 6th Edition Editor: Garden & Bradbury & Forsythe &Parks Churchill
Livingstone
3. Norman L. Browse an introduction to the Symptoms and signs of surgical Disease 4th edition, Edward Arnold
4. Peter F Lawrence (2013), Essential of general surgery, 5th edition, Lippincott Williams and Wilkins, a Wolters
Klumer business.
`
Recommended scientific websites & Guidelines:
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Important Remarks
Attendance:




All Tutors have to take the attendance by calling names of students and tick in front of
the name.
According to the University regulations and instructions, we would like to inform you
that, each student has to cover at least 75% of the attendance in lectures/clinics
Those who do not achieve this percentage will not be allowed to attend the FINAL
EXAMINATION. The first warning letter will be issued if you did not attend 15% of
lectures (about 6 lectures).
If you continued not to attend, the lectures and your absence reached 25%. The second
letter will be directed to Vice Dean, Educational Affairs to be not allowed to attend the
final examination.
Warning:

As it is not a sign of courtesy and keenness, to be non-punctual in addition to its bad
effect on the teaching course plan, please try to enter the class before the teacher starts
his lecture. You should know that if you arrived 15 minutes late after start of the
lecture, the teacher might allow you to attend but your name will be taken, and your
signature will be cancelled and will be considered absent in this lecture.
Courtesy:
If you have problems with getting to a session, please discuss it with your tutor in advance
or with the organizer.
On the Written Exam Day, Note the following please:
 Cell Phones & all electronic devices are NOT Allowed in the Exams.
 Make sure you are in the exam room at least 15 minutes before the scheduled
starting time
 Be sure to bring your own stationary box (pencil, eraser, calculator, pen), water
bottle, and tissue as there will be no borrowing allowed for stationary stuff
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Appendix 1
GUIDELINES FOR PRESENTATION/LECTURER
I. SPEAKER
*
Be relaxed and confident with clear voice and language.
*
Good eye contact does not speak to your screen.
*
Sense of humor, if you are good at it.
*
Changing style, bodily actions and gestures will help you.
*
Use interactivity in the presentation (Avoid didactic presentations)
*
Stick to your time and break in between if longer.
*
Know about your audience and level of knowledge and keep them attentive.
*
Rehearse your presentation in advance, well-prepared and up-dated topic.
II. TECHNIQUE AND FACILITIES:
*
Choosing appropriate facilities according to time and presentations.
*
Arrange before and check audio-visual aids.
*
Slide presentation should be:
[a]
Not more than 6 lines in a slide and not more than 8 words per line.
[b]
Letters must be large and bolder
[c]
Correct spelling and avoid unknown abbreviation.
III. CONTENT OF A TOPIC [THE FORMAT]
*
Title brief, clear and projection
*
Introduction what you are going to do, give an overview of whole subject.
*
Objectives
*
Subject Proper
*
Questions/Discussion
*
Summary/Conclusion
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
Appendix 2
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
SURG 551 Course Student & Tutor Guide 2019-2020
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COLLEGE OF MEDICINE
DEPARTMENT OF CLINICAL SCIENCES
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