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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.
Topics in this domain
From the free sample — original, referenced, with the full explanation. Rate your confidence first.
A 23-year-old woman has 24 hours of vomiting and diffuse abdominal pain. She is drowsy, with respiratory rate 30/min, pulse 124 bpm and BP 96/58 mmHg; the abdomen is diffusely tender with guarding. Venous gas: pH 7.08, bicarbonate 7 mmol/L, glucose 27 mmol/L, lactate 2.1 mmol/L. WCC 22 × 10⁹/L, amylase 210 U/L.
What is the most appropriate next step?
A 74-year-old male smoker attends a district general hospital that has no on-site vascular service with sudden abdominal and left loin pain. He is alert, with a pulse of 104 bpm and BP 108/70 mmHg. Bedside ultrasound by the emergency physician shows an abdominal aorta 7.2 cm in diameter.
What is the most appropriate next step?
Acute appendicitis for FRCS (Gen Surg): Alvarado, AIR and Adult Appendicitis scores, imaging by patient group, antibiotics or surgery, and the appendix mass.
Read · 9 minAcute upper GI bleeding for FRCS (Gen Surg): Glasgow-Blatchford and Rockall scores, Forrest stigmata, NICE CG141, variceal care, embolisation and ulcer surgery.
Read · 10 minThe JCIE publishes no weightings, but the examination is set at the standard of a day-one consultant on the emergency take, and many of the JCIE’s sample questions are emergency scenarios. It is the largest domain in our bank for that reason.
Yes. The syllabus includes emergency aneurysm disease, mesenteric vascular disease and acute limb ischaemia, at the level a general surgeon on call needs: recognition, resuscitation, imaging, the first decisions and referral.
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