FRCS (Gen Surg) revision topics

01

Principles

4 topics · 175 questions in the bank

This domain is the part of general surgery that every other domain rests on. It covers preoperative assessment and enhanced recovery, nutrition and intestinal failure, sepsis, fluids and critical care, thromboprophylaxis and anticoagulation, blood products, the biology and staging of cancer and the principles of systemic and radiotherapy, the hereditary cancer syndromes, skin lesions and soft-tissue infection, and the spleen. It also covers the professional curriculum the JCIE examines: statistics and study design, critical appraisal, consent, capacity, safeguarding, the law, patient safety, audit and supervision. The JCIE’s own sample questions include several items from this area, and it is the domain candidates most often under-revise.

• Perioperative care, nutrition & critical care

  Preoperative assessment, risk & enhanced recovery · Surgical nutrition & intestinal failure · Sepsis, fluids & critical care · Thromboembolism, anticoagulation & blood products

  50

• Oncology & genetics for surgeons

  Cancer biology, staging & the MDT · Chemotherapy, radiotherapy & systemic therapy · Hereditary cancer syndromes & genetics

  25

• Statistics, research, ethics & law

  Statistics & data presentation · Study design, bias & critical appraisal · Consent, capacity, safeguarding & the law · Patient safety, audit, governance & supervision

  75

• Skin, soft tissue & the reticulo-endothelial system

  Skin and subcutaneous lesions, including melanoma · Superficial sepsis & necrotising soft-tissue infection · Spleen, lymph nodes & lymphoma

  25

02

Emergency

5 topics · 275 questions in the bank

The emergency take is the heart of the day-one consultant standard: every consultant general surgeon is on call for everything, whatever their special interest. This domain covers the assessment and imaging of the acute abdomen, appendicitis, perforation and peritonitis, acute gynaecological disease and the abdomen in pregnancy, small and large bowel obstruction and volvulus, the strangulated hernia, upper and lower GI bleeding, emergency laparotomy and the frail older patient, anastomotic leak and intra-abdominal sepsis, abdominal compartment syndrome and the open abdomen, enterocutaneous fistula, and the vascular emergencies a general surgeon must recognise and start to manage — the ruptured aneurysm, acute mesenteric ischaemia and the acutely ischaemic limb. It is the largest domain in our map of the syllabus.

• Acute abdomen, appendicitis & peritonitis

  Assessment and imaging of the acute abdomen · Acute appendicitis · Perforation & generalised peritonitis · Acute gynaecological disease & the abdomen in pregnancy

  75

• Intestinal obstruction & volvulus

  Small bowel and adhesional obstruction · Large bowel obstruction & pseudo-obstruction · Sigmoid, caecal & gastric volvulus · Strangulated and obstructed hernia

  50

• Gastrointestinal bleeding

  Acute upper GI haemorrhage & varices · Lower GI bleeding · Bleeding on anticoagulants & transfusion

  50

• Emergency laparotomy & complications of abdominal surgery

  Emergency laparotomy, risk scoring & the older patient · Anastomotic leak & intra-abdominal sepsis · Abdominal compartment syndrome & the open abdomen · Dehiscence, closure & enterocutaneous fistula

  50

• Emergency vascular surgery

  Ruptured and symptomatic aortic aneurysm · Acute mesenteric ischaemia · Acute limb ischaemia & compartment syndrome

  50

03

Trauma

3 topics · 125 questions in the bank

Trauma for the general surgeon is resuscitation and the abdomen, with enough of everything else to run the first hour safely. The domain covers trauma systems and the primary survey, haemorrhage control and haemostatic resuscitation, damage control surgery and the tertiary survey; liver, spleen, kidney, pancreatic and duodenal injury; bowel, colorectal, perineal and diaphragmatic injury; penetrating abdominal trauma; and the head and neck, thoracic, vascular and soft-tissue injuries a general surgeon must recognise and start to manage. Paediatric trauma is covered with paediatric surgery.

• Trauma systems, resuscitation & damage control

  Primary survey, triage & trauma systems · Haemorrhage control & haemostatic resuscitation · Damage control surgery & tertiary survey

  50

• Abdominal & pelvic trauma

  Liver, spleen & kidney injury · Pancreatic & duodenal injury · Bowel, colorectal, perineal & diaphragmatic injury · Penetrating abdominal trauma

  50

• Head, chest, vascular & soft-tissue trauma

  Head and neck injury for the general surgeon · Thoracic trauma · Vascular, extremity & soft-tissue injury

  25

04

Upper GI

4 topics · 175 questions in the bank

Oesophago-gastric surgery spans benign disease, cancer and obesity. The domain covers reflux and hiatus hernia, achalasia and the motility disorders, oesophageal perforation, strictures and foreign bodies; Barrett’s oesophagus and early neoplasia, the staging and treatment of oesophageal, junctional and gastric cancer, GIST, lymphoma and gastroduodenal polyps; peptic ulcer disease and its complications, and reconstruction after gastrectomy; and obesity and metabolic surgery — selection, the operations, and their early and late complications, including the bariatric patient who presents to a general surgeon on call.

• Benign oesophageal disease

  Reflux disease & hiatus hernia · Achalasia & motility disorders · Oesophageal perforation, strictures & foreign bodies

  50

• Oesophageal & gastric cancer

  Barrett's oesophagus & early neoplasia · Oesophageal & junctional cancer · Gastric cancer · GIST, lymphoma & gastroduodenal polyps

  50

• Benign gastroduodenal disease

  Peptic ulcer disease & its complications · Gastric surgery, reconstruction & its sequelae

  25

• Obesity & metabolic surgery

  Selection, assessment & the obese surgical patient · Bariatric procedures & outcomes · Early & late complications of bariatric surgery

  50

05

HPB

4 topics · 175 questions in the bank

HPB is where the emergency take and specialist surgery meet most often. The domain covers gallstones, cholecystitis and cholecystectomy, bile duct stones, cholangitis and ERCP, bile duct injury and benign biliary disease; acute pancreatitis, its severity, collections and late complications, and chronic pancreatitis; pancreatic and periampullary cancer, cystic neoplasms and intraductal papillary mucinous neoplasms; colorectal liver metastases, hepatocellular carcinoma, cholangiocarcinoma and gallbladder cancer, benign and cystic liver lesions; and portal hypertension and liver failure.

• Gallstones & benign biliary disease

  Gallstones, cholecystitis & cholecystectomy · Bile duct stones, cholangitis & ERCP · Bile duct injury & benign biliary disease

  50

• Acute & chronic pancreatitis

  Acute pancreatitis: severity & early management · Pancreatic collections, necrosis & late complications · Chronic pancreatitis

  50

• Pancreatic & periampullary neoplasia

  Pancreatic & periampullary cancer · Cystic neoplasms & IPMN

  25

• Liver tumours & portal hypertension

  Colorectal liver metastases · Hepatocellular carcinoma, cholangiocarcinoma & gallbladder cancer · Benign and cystic liver lesions · Portal hypertension & liver failure

  50

06

Colorectal

6 topics · 225 questions in the bank

Colorectal surgery is the second-largest domain in our map of the syllabus, and much of it arrives through the emergency take. It covers polyps and the polyposis and Lynch syndromes, bowel cancer screening and surveillance, colon cancer; rectal cancer staging, surgery, neoadjuvant treatment and organ preservation, recurrent disease and anal cancer; ulcerative colitis and acute severe colitis, Crohn’s disease and the other colitides; diverticular disease and stomas; haemorrhoids, fissure, anorectal sepsis, fistula, pilonidal disease and hidradenitis; and faecal incontinence, rectal prolapse, constipation and pelvic pain.

• Polyps, screening & colon cancer

  Polyps & polyposis syndromes · Bowel cancer screening & surveillance · Colon cancer

  50

• Rectal & anal cancer

  Rectal cancer staging & the MDT · Rectal cancer surgery, neoadjuvant therapy & organ preservation · Recurrent disease, anal cancer & other malignancies

  50

• Inflammatory bowel disease & colitis

  Ulcerative colitis & acute severe colitis · Crohn's disease · Ischaemic, infective, radiation & other colitides

  50

• Diverticular disease & stomas

  Diverticular disease & diverticulitis · Stomas & their complications

  25

• Benign anorectal disease

  Haemorrhoids & anal fissure · Anorectal sepsis, fistula, pilonidal disease & hidradenitis

  25

• Pelvic floor & functional bowel disorders

  Faecal incontinence, rectal prolapse & solitary ulcer · Constipation, obstructed defaecation & chronic pain

  25

07

Breast

2 topics · 100 questions in the bank

Breast surgery is examined at the generality level, so a gastrointestinal surgeon needs it as much as a breast surgeon needs the emergency take. The domain covers triple assessment and imaging, the NHS Breast Screening Programme and the management of family history, benign breast disease, breast sepsis and gynaecomastia; the pathology and prognosis of breast cancer and ductal carcinoma in situ, surgery of the breast and axilla, oncoplastic surgery and reconstruction, adjuvant, neoadjuvant and endocrine therapy, and advanced disease and special situations such as pregnancy and the male breast.

• Breast assessment, screening & benign disease

  Triple assessment & breast imaging · NHS Breast Screening Programme & family history · Benign breast disease, sepsis & gynaecomastia

  25

• Breast cancer

  Pathology, prognosis & DCIS · Surgery of the breast & axilla · Oncoplastic surgery & reconstruction · Adjuvant, neoadjuvant & endocrine therapy · Advanced disease & special situations

  75

08

Endocrine

2 topics · 100 questions in the bank

Endocrine surgery rewards precise knowledge of a small number of pathways. The domain covers neck swellings and lymphadenopathy, thyroid nodules and their cytology, thyroid cancer, goitre and thyrotoxicosis, thyroidectomy and its complications; primary, secondary and tertiary hyperparathyroidism and parathyroid surgery; adrenal incidentaloma, Cushing’s syndrome and Conn’s syndrome, phaeochromocytoma and paraganglioma; and neuroendocrine tumours and the multiple endocrine neoplasia syndromes.

• Thyroid & neck swellings

  Neck swellings & lymphadenopathy · Thyroid nodules & thyroid cancer · Goitre & thyrotoxicosis · Thyroidectomy & its complications

  50

• Parathyroid, adrenal & neuroendocrine disease

  Hyperparathyroidism & parathyroid surgery · Adrenal incidentaloma, Cushing's & Conn's · Phaeochromocytoma & paraganglioma · Neuroendocrine tumours & MEN syndromes

  50

09

Hernia

1 topics · 50 questions in the bank

Hernia surgery is common, and so are its questions of anatomy, technique and judgement. The domain covers inguinal and femoral hernia, umbilical, incisional and complex ventral hernia, mesh choice and position, laparoscopic and open repair, chronic postoperative groin pain, and the closure of the abdominal wall to prevent incisional hernia. The emergency presentation of a strangulated or obstructed hernia is examined with emergency surgery.

• Groin & ventral hernia

  Inguinal & femoral hernia · Umbilical, incisional & complex ventral hernia · Mesh, laparoscopic repair & abdominal wall closure

  50

10

Transplant

1 topics · 25 questions in the bank

Transplantation is a small domain, examined at the level a general surgeon needs: recognising the early complications of a transplant, understanding the drugs these patients take, and knowing the principles of organ donation and dialysis access. It covers transplant immunology and rejection, immunosuppressive drugs and their toxicities, organ donation after brain-stem and circulatory death and organ retrieval, kidney, pancreas and liver transplantation, and arteriovenous fistulas, grafts and peritoneal dialysis access.

• Transplantation & dialysis access

  Transplant immunology, immunosuppression & organ donation · Kidney, pancreas & liver transplantation · Dialysis access

  25

11

Paediatrics

1 topics · 75 questions in the bank

Many general surgeons operate on children, and all of them assess children on call. The domain covers the child with abdominal pain or vomiting — pyloric stenosis, malrotation, intussusception and appendicitis — the groin, scrotal and umbilical conditions of childhood, including the undescended testis and testicular torsion, paediatric trauma and safeguarding, and head and neck swellings and other childhood conditions. The JCIE’s sample questions include several items from this area.

• Paediatric general surgery

  The child with abdominal pain or vomiting · Groin, scrotal & umbilical conditions · Paediatric trauma & safeguarding · Head and neck swellings & other childhood conditions

  75