“Professional competence” General Surgery Examination program
Explanation: Examination question is given in plain text, Italic text means the contents of the question
Asepsis and antisepsis
1.Chain of infection spread. Infection: sources, exit gate, transmission routes, entrance gate, patient.
2. Factors influencing the spread of infection. Age, local and general immunity, chronic diseases, tissue injury,
disturbances of circulation, invasive procedures, medicines ( immunosuppresors, cytostatics, hormones,
antibiotics), neglecting hygiene requirements, sanitary state.
3. Universal precautions for prevention of infection of patients and health care workers. Prevention of HIV,
hepatitis.
4. Standard precautions: hand washing, gloves, protective eye and/or facial wear, prevention of sharps injuries,
correct preparation of nursing devices and instruments, following hygiene requirements, correct handling of medical waste.
5. Asepsis: definition, background and founders. Conception of asepsis. Types of asepsis: medical and
surgical. Surgery before the era of asepsis. Contribution to asepsis of O. W. Holmes, I. Semmelweis, L. Pasteur,
W. S. Halsted , E. von Bergman.
6. Medical asepsis: definition, basic principles. Hand washing, gloves, barriers for infection prevention, disinfection, sterilisation, prevention of sharps injuries, and disposal of medical waste.
7. Hand hygiene of health care workers. Resident and transient microbial flora of the skin. Indications for hygienic hand washing.
8. Hygienic hand washing: purpose, methods and ways. Hygienic hand washing and hand antisepsis: purpose,
ways (routine hand washing, hand washing with plain soap, antimicrobial soap, detergents, antiseptics). Procedure. Duration.
9. Medical gloves: types, indications for use. Types: sterile surgical, single-use examination, utility gloves.
10. Preventive measures against infection for the health care staff and the patients. Masks, caps, protective
eye and/or facial wear, clothing, footwear. Indications, directions for use.
11. Cleaning of the surgical department. Conception of “cleaning” and “decontamination”. Wound dressing
rooms: purpose, equipment requirements, specificity of cleaning.
12. Methods of infection control. Conceptions of decontamination, disinfection and sterilisation. Physical,
chemical, mechanical and biological methods of infection control.
13. Disinfection: definition, levels and methods. High, intermediate and low level disinfection. Methods of disinfection: physical, chemical.
14. Disinfecting and antiseptic agents. Disinfectant: conception, purpose. Most commonly used disinfectants.
Requirements, characteristics.
15. Sterilization: definition, methods, ways.
16. Autoclaving, gaseous chemical sterilization, irradiation, chemical sterilization, boiling: characterisation, application, regimens.
17. Stages of disinfection and sterilization. Decontamination, cleaning, sterilization or high level disinfection,
storage. Ways of decontamination and cleaning. Contamination control. Characterization of stages according to
the applied method.
18. Spaulding’s classification. Classification of instruments and nursing devices based on necessary cleanliness
and sterility.
19. Sterilization of surgical instruments and equipment. Preparation for sterilization. Methods and ways of
sterilization. Sterilization of optic instruments.
20. Wound dressing material, sterilization. Requirements for wound dressing material. Preparation for sterilization, features of packaging. Single use wound dressing material.
21. Sterilization of gowns, operative field draping material. Preparation for sterilization, features of packaging, ways of sterilization. Disposable masks, caps, gowns, draping: characterization.
22. Disposable medical items: advantages and drawbacks. Sterilization of disposable medical items.
23. Methods of sterilization process and sterility control. Mechanical, chemical, biological and combined
methods. Advantages and disadvantages. Markers of the modern biological sterility control.
24. Transportation and storage of sterile materials, sterile shelf life. Sterile shelf life, prolongation possibilities.
25. Medical waste: types, hazards, storage and handling. Potential hazards to health care workers, patients,
visitors, community. Directions for sorting, storage, decontamination and disposal.
26. Surgical asepsis: definition, conception of “sterile” and “aseptic” technique.
27. Main principles of surgical asepsis.
28. Operating block. Principles of equipment of the operating theaters. Purposes of rooms in the operating
block. Open, semi-closed and closed zones. Equipment requirements. Traffic directions of staff and patients.
29. Staff of the operating block, functions, outfit, work regulations.
30. Cleaning of the operating theater. Air quality control in the operating theater. Ventilation and heating systems. Outfit requirements for the staff, dressing features of the staff. Work and behavior regulations.
31. Surgical hand disinfection procedures (surgical hand washing). Hygiene requirements for the surgeon’s
and scrub nurse’s hands. Ways of surgical hand scrub, equipment, antiseptics, technique.
32. Modern surgical gloves. Purposes of gloves. Types, purposes, properties. Sterilization of gloves. Double and
triple gloving, indications for use. Gloving procedures.
33. Indications for washing and changing of gloves. Changing gloves in case of perforation. Preventive measures in case of sharps injury. Glove removal after an operation. Hand care. Allergy to latex.
34. Masks, caps, footwear, outfit, protective eye wear and face shields used in the operating theater. Requirements, properties, rules of use. Impervious gowns. Pinafore. Sterility signs and borders of the surgical attire.
Rules of removal of the surgical attire. Footwear cleaning after an operation.
35. Preparation and isolation of the operative field. Preparation of the operative field before arrival in the operative theater, in the operative theatre, surgical wound asepsis after an operation. Hair removal, antisepsis,
technique. Drapig items, features. Operative field protectors. Sterility signs and borders of the draped area.
36. Asepsis during operation. Movement of staff in the operating theatre, talking, storage of unused sterile
items, cleaning of used instruments, size of the surgical wound, tissues and organs sparing surgical technique, hemostasis, nonsterile and sterile stage of the operation, disposal of medical waste.
37. Antisepsis: definition, background, founders. Problems in surgery before the era of antisepsis. Works of J.
Lister, L. Pasteur, A. Fleming.
38. Types and methods of antisepsis.
39. Antiseptics: classification, fields of application. Disinfectants, antisepticts and chemotherapeutic agents.
40. Antiseptics. Groups of chemical agents: halides, oxidizing agents, alcohols, phenol derivatives, aldehydes,
detergents, nitrofuran derivatives, salts of heavy metals, acids, alkali, antibacterial dyes, antibiotics, sulphanylamides.
41. Modern antisepsis. Conception of an antiseptic. Requirements for the modern antiseptic. Viral antisepsis.
42. Currently used antiseptic agents. Skin, wound antiseptics, hand antiseptics, antiseptics for surgical scrubbing and operative field preparation.
Nutrition of a patient
43. Protein and energy stores in the body. Energy requirements of healthy and ill subjects. Principles of calculation of energy requirements. Conceptions of “catabolic“ and “anabolic“ state, metabolic effect. Body response to stress in tems of metabolism, stages of post-stress period. Average energy stores of the human body,
protein stores in the tissues.
44. Calculation of energy requirements. Calculation according to the ideal body weight, Harris-Benedict equation, basic energy requirements, real energy consumption: stress, activity, temperature factors. Average energy requirements of healthy, operated person and the surgical patient. Protein neeis, needs of micro- and macro elements.
45. Causes of malnutrition, main clinical signs: anamnesis, anthropometric, laboratory tests. Causes of malnutrition of patients and influence of hospitalization on nutrition. Principles of assessment of nutritional state:
anamnesis, physical state of the patient, influence of intended procedures, anthropometric evaluation, laboratory
tests and skin tests.
46. Principles of nutrition of patients. Enteral nutrition: indications, principles, complications, benefits.
Oral nutrition, conception of supplementary feeding. Enteral tube feeding: conception, indications, classification.
47. Principles of nutrition of patients. Gastrostomy and jejunostomy: indications, construction principles, care.
Technical aspects of enteral nutrition, enteral nutrition formulas, principles of administration, indications. Most
common complications of enteral feeding: mechanical, infectious, metabolic, ways of prevention. Enteral feeding:
physiology, advantages over parenteral feeding.
48. Parenteral nutrition: indications, principles, complications, benefits. Types of parenteral nutrition. Principles of needs calculation. Parenteral nutrition solutions, all-in-one nutrient solutions. Most common complications of parenteral nutrition, prevention.
Examination of a patient
49. Diagnostic stage: duration, purposes, preoperative preparation. Indications for operation. Assessment of
an operative risk. Additional preoperative investigations. Psychological preparation of patient. Preoperative preparation of a patient.
50. Subjective examination of the surgical patient. Complaints and anamnesis. Past medical history. History of
previous diseases. Familial anamnesis.
51. Physical examination of the patient. Inspection. Auscultation. Percussion. Palpation.
52. Laboratory tests. Morphological, biochemical, bacteriological, and immunological tests. Bacteriological
tests of bloodand fluids from the abdominal cavity.
53. Instrumental investigations of a surgical patient: endoscopy, biopsy. Classification, methods, purposes.
54. Radiological investigation methods. X-rays, CT, MRI, radioisotope, ultrasound.
55. Examination of vascular surgery patient.
56. Diagnosis of diseases of the colon.
57. Diagnosis of diseases of the rectum. Function tests of anal sphincters and rectum.
Operation
58. Preoperative period: stages, duration. Preoperative epicrisis. Stages of preoperative period. Duration and
tasks of the stages.
59. General and local preparation for elective and urgent surgery. Main procedures of preparation. Preparation for elective and urgent surgery.
60. Operation: indications, contraindications, classification. Principal moments of an operation. Indications
for elective and urgent operations. Classification of indications: absolute, relative. Classification of operations.
61. Operative risk: main factors risk factors, assessment. ASA classification of physical state, cardiac and
thromboembolism risk factors. Operative risk.
62. Surgical tissue dissection. Measures, ways and principles of the surgical tissue dissection.
63. Tissue restoration. Measures, ways and principles of the surgical tissue restoration.
64. Wound healing: significance of tissue injury, microcirculatory disturbances, and hemostasis. Minimal
tissue injury. Hemostasis. Microcirculatory disturbances. Crush sindrome. Traumatic uremia.
65. Drainage of wounds and cavities: indications, types, possible complications. Types of drains. Ways of
drainage. Complications. Drainage duration criteria.
66. Postoperative period: stages, prevention of complications. Duration of stages, tasks (nursing, prevention
of complications, regeneration, working-capacity).
67. Post-operative disease. Adaptation syndrome. Phases: catabolic, transitional, anabolic, complete restoration.
68. Operative wound care, possible complications, prevention. Operative wound complications: early, late.
Prevention of surgical site infection.
69. Postoperative care of respiratory system, possible complications, prevention. Possible postoperative respiratory complications. Prevention of complications during preoperative and postoperative period.
70. Postoperative functional disorders of the gastrointestinal tract, prevention and management. Single or
continuous gastric tube decompression, activation of peristalsis, activation of a patient.
71. Postoperative urination disorders, prevention, principles of management. Urinary retention: diagnosis,
prevention. Stimulation of urination reflex. Urinary bladder catheterization. Normal diuresis.
72. Postoperative thrombosis and thromboembolism, prevention. Three main factors of pathogenesis. Early
and late postoperative thromboembolism. Risk factors.
73. Postoperative thrombosis and thromboembolism, prevention. Prevention stages: preoperative, intraoperative, and postoperative. Management of leg vein varicosis, elastic antiemboli stockings, mobilization of patient,
leg massage, oxygen therapy, correction of fluid balance, anticoagulants. Monitoring of blood coagulation.
74. Bed sores, prevention. Characterization. Causes. Localization. Stages. Prevention.
75. Postoperative fever, causes, prevention. Infectious and non-infectious fever. Spread of purulent infection;
malignant hyperthermia; transfusion reactions. Fever immediately after an operation, after 36 hours, after 3
days. Less common causes of fever.
76. Assessment of body temperature, pulse, body weight, urine output during the postoperative period. Recording. Continuous data monitoring. Morphological and biochemical blood tests. Assessment of body weight
changes. Short-term and long-term loss of body weight. Physiological and pathological fluid excretion. Correlation between body temperature, respiratory rate and loss of fluids.
Wound
77. Wound: signs, types. Definition. Symptoms. Types according to contamination, extent of organ injury, depth
of wound channel.
78. Classification of wounds. Anamnesis of wound. Classification according to the origin, nature of injury and
specificity.
79. First aid for wound. Prevention of wound infection. Hemostasis, dressing of wound. Empirical asepsis and
antisepsis during the first aid.
80. Gunshot wound: types, specific features. Damage zones of the gunshot wound. Primary closure of a gunshot wound. Types of a gunshot wound .
81. Infected wounds and bites: signs, first aid, principles of management. Bite wounds, especcially made by
rabid animals. Snakebites. Signs of intoxication. First aid. Bee sting, first aid.
82. Surgical wound. Conception. Healing process, complications. Surgical and accidental wound. Definition of
surgical wound. Hemorrhage after wound closure, wound dehiscence. Scar formation during healing by primary
intention. Scar formation during healing by secondary intention. Scar hypertrophy, causes. Keloid formation in
the scar. Scar complications.
83. Wound heeling: characterization of phases, ways of wound healing, factors influencing wound healing.
84. Healing of purulent wound: periods, phases. Reinspection and debridement of the wound. Phases. Forms
of their clinical expression, stages.
85. Wound complications: tetanus, rabies. Signs, prevention, principles of management.
Tissue vascularization disturbances and tissue necroses
86. Acute artery and vein occlusion: causes, symptoms, diagnosis, first aid and principles of management.
External and internal causes of occlusion. Signs of arterial occlusion: subjective, objective. Doppler, ultrasound,
and contrast x-ray investigation methods. First aid.
87. Acute artery and vein occlusion. Conservative and surgical management. Outcomes, prognosis. Acute occlusion of deep leg veins. Subjective and objective signs. Acute occlusion of the deep leg veins. Conservative and
surgical treatment. Complications. First aid. Filters of the inferior caval vein.
88. Obliterative endarteritis: etiology, causes, signs, diagnostics, principles of treatment. Morbus Raynaud.
Intermittent claudication. Implications of smoking. Radiological investigations. Prevention. Conservative and
surgical treatment. Outcomes. Amputations.
89. Diseases causing occlusion of leg arteries: causes, signs, diagnostics and principles of treatment. Noninvasive and invasive methods of investigation. Conservative and surgical ways of treatment. Endovascular, angioplastic dilatation.
90. Diabetic angiopathies. “Diabetic foot”: signs, diagnostics, principles of treatment. Macroangiopathy. Microangiopathy. Neurotrophic and neuroischemic disorders. Subjective and objective signs. Significance of noninvasive and invasive investigations. Conservative and surgical treatment. Prevention, nursing.
91. Superficial leg vein varicosis: etiology, pathogenesis, signs, diagnostics, principles of treatment. Subjective and objective signs. Non-invasive and invasive ways of investigation. Prevention. Conservative and operative
treatment.
92. Superficial phlebitis and thrombophlebitis: etiology, signs, diagnostics, principles of treatment, prevention. Definition. Causes. Pathogenetic factors. Superficial and deep phlebitis. Sources of infection. Local and
general conservative treatment. Physiotherapy. Surgical treatment. Prevention.
93. Phlebothrombosis: etiology, pathogenesis, signs, diagnostics, principles of treatment, prevention. Definition. Pathogenetic factors. Symptoms. Management. Prevention.
94. Microcirculatory changes in tissues: necrosis, gangrena, forms, causes, signs, diagnostics, principles of
treatment. Bed sores. Tissue vitality. External and internal causes. Necroses. Dry and wet necrosis. Conservative
and surgical treatment. Prevention, nursing.
95. Ulcers: classification, causes, signs, diagnostics, principles of treatment. Signs. Classification. Ulcers as a
result of external factors. Disease related ulcers. Treatment, prevention. Consequences.
96. Fistulas: classification, causes, signs, diagnostics, principles of treatment. Mechanism of development. Artificial fistulas of the gastrointestinal tract. Urinary fistulas. Foreign body fistulas. Diagnostics. Principles of
treatment. Outcomes, nursing, prevention.
General surgery practical skills
1. Surgical hand antisepsis.
2. Wearing the gown and gloving procedure.
3. Palpation of peripheral arteries.
4. Removal of stitches from a wound.
5. Dressing an aseptic wound.
6. Dressing an infected wound.
7. Removal of stitches.
8. Insertion of the gastric tube.
9. Insertion of the urinary catheter.
10. Interviewing the patient.
11. Assessment of the abdominal inspection findings.
12. Assessment of the abdominal auscultation findings.
13. Assessment of the abdominal percussion findings.
14. Light abdominal palpation.
15. Deep abdominal palpation.
16. Palpation of the liver, spleen, cecum, the sigmoid colon.
17. Assessment of the peritoneal irritation signs.
18. Detection of fluid accumulation (ascites) in the peritoneal cavity.
19. Technique and assessment of the digital examination of the rectum.
20. Palpation an assessment of hernia opening.
21. Examination of the deep leg veins.
22. Examination of the superficial leg veins.
23. Evaluation of the peripheral arterial blood flow.
24. Palpation of the peripheral lymph nodes.
25. Assessment of the superficial abscess signs.
26. Breast palpation.