Introduction to Surgery 2 (SURG 636) M K ALAM MS FRCS Professor of Surgery AL MAAREFA COLLEGE

Aims To prepare professional clinicians with sound knowledge, skills, understanding and appropriate attitudes ready to qualify in the graduating examination. They should be ready to specialize and practice in the field of medical science of their choice.

Theoretical objectives To provide a broad based knowledge of diseases in the field of general surgery To provide basic knowledge of diseases in the field of surgical specialties

Clinical objectives Perform and demonstrate careful history taking. Perform and demonstrate a comprehensive clinical examination. Demonstrate appropriate skills to interpret clinical signs. Record and produce full & summarized history & clinical examinations. Demonstrate knowledge of the symptoms & signs of common surgical diseases. Demonstrate skill to formulate a reasonable differential diagnoses.

Clinical objectives Justify investigations & interpret its findings. Show the need for careful, accurate and speedy decision making. Demonstrate getting involved with surgical emergencies & critically ill patients. Demonstrate the skill to choose from the spectrum of surgical care ( operative vs non-operative). Demonstrate self-learning & use of different resources of teaching aids Demonstrate dedication, concern, confidentiality of information. Demonstrate professional manners.

COURSE DESCRIPTION Surgery 2 (SURG 636) Six (6) weeks.

Course plan Week 1: Lectures Week 2: Hospital posting & Tutorial Week 4: SUNDAY- Mid-Block examination & Hospital posting Week 5: Hospital posting & Case presentation (Tutorial day) Week 6: End Block examination

Teaching Format Lectures Hospital posting Tutorials (Interactive sessions): Case scenarios/ interpretation of lab. results/ imaging studies/ spot diagnosis/ common instruments

Principles of surgery General surgery Urology Thoracic surgery Syllabus Course will include topics from: Principles of surgery General surgery Urology Thoracic surgery Neurosurgery Plastic surgery Pediatric surgery Vascular surgery

Principles of Surgery Anaesthesia and pain management Sterilization, aseptic technique & operation room (Sutures, diathermy, drains, laparoscopic surgery) Day surgery Principles of transplantation surgery

General Surgery Upper GI hemorrhage. Lower GI hemorrhage Small bowel obstruction Large bowel obstruction and colostomies Obstructive jaundice Surgical management of morbid obesity in adults (Bariatric surgery)

Urology General presentation, assessment and investigations of urinary tract diseases. Diseases of upper urinary tract (kidney & ureter) Diseases of lower urinary tract (bladder, prostate, urethra) Diseases of external genitalia: Circumcision, Congenital abnormalities of the penis, undescended testis (cryptorchidism), Torsion of the testis, Epididymo-orchitis, hydrocele, Varicocoele.

Thoracic surgery Diseases of oesophagus Mediastinum, and pleuro-pulmonary infections Presentation and management of: Bronchogenic carcinoma, other lung tumours including metastatic carcinoma, mesothelioma.

Pediatric surgery Common neonatal emergencies: Hirschsprung’s disease, Esophageal atresia, Imperforated anus, intestinal atresia, Pediatric emergencies: Acute appendicitis, intussusception, Meckel’s diverticulum, Foreign bodies, perianal sepsis Hernias, abdominal wall defects, undescended testis, childhood obesity

Vascular surgery 1. Arterial diseases Venous diseases & lymphatic diseases

Plastic surgery Management of burn Skin and subcutaneous tumours

Neurosurgery Management of head injury Intracranial tumours and infections

Teaching program: SURG 2 (636) Semester 161 Date 11-12-16 to 12-01-17 Day 8 - 8.50 AM 8.50 - 9.40 AM Break 9.40 - 10 AM 10-10.50 10.50-11.40 Prayer 11.40-1PM 1-2 PM 2-3 PM SUNDAY 11-12-16 Small bowel obstruction   Prof. AlSaigh Upper GI bleeding Introduction to Surgery 2 Prof. Alam Day Surgery Prof Alam Chronic Arterial disease Dr. Qaisar Venous & lymphatic diseases MONDAY 12-12-16 Lower GI bleeding Principles of transplantation surgery Sterilization, aseptic technique and operation room Acute limb ischemia Hernias, abdominal wall defects, undescended testis, childhood obesity Dr. S Mallick TUESDAY 13-12-16 General presentation, assessment and investigations of urinary tract diseases Dr. M Turki Diseases of upper urinary tract (kidney & ureter) Diseases of oesophagus Dr. Waseem Hajjar Diseases of mediastinum & pleuro-pulmonary infections Management of head injury+ Raised ICP Dr. Safdar Intracranial tumors and infections WEDNESDAY 14-12-16 Management of Burn Dr. Shareef Management of skin & subcutaneous tumours, skin grafts Surgical management of morbid obesity in adults Anaesthesia and pain management Dr. Bilal Common neonatal emergencies Pediatric emergencies THURSDAY 15-12-16 Diseases of lower urinary tract Diseases of external genitalia Obstructive jaundice Introduction to minimally invasive surgery Large Intestinal obstruction and colostomies Dr. Alam Bronchogenic carcinoma, other lung tumours, metastatic carcinoma and mesothelioma (2-3 PM)

Weeks 2-5: Clinical rotation. 4 days- fully spent in the hospital. Thursdays: In the college for tutorials

Hospital postings- 4weeks Surgical units: In-patient, operating room, emergency room & OPD .Actively participate in history taking, physical examination and discussing differential diagnosis. Present patient’s case history, physical examination and participate in case discussion with in-charge clinicians. Expected to master history taking and perform clinical examination on surgical patients as well as participating in patient-care related activities. Follow up and interpret investigation (blood, imaging) results. Discuss management plan and attend surgery with the treating team.

Hospital postings Maintain a logbook- document all patients seen, procedures attended/participated (signed by a consultant/ registrar/ tutor.) Display professional behavior at all time. Must abide by the hospital rules. Must strictly adhere to the confidentiality of patients and hospital. Must follow the dress code. Carry own pen torch and stethoscope.

SKILLS/PROCEDURES- AT HOSPITAL History & examination of different organ systems Study of imaging studies Interpretation of laboratory investigations Nasogastric tube Wound drains Wound care IV line PR exam Prostate examination Proctoscopy Suturing Urinary catheterization (Male & Female) Colostomy care (if available)

Hospital posting & Tutorials, Surg. 2 636 Semester 161 Day 8 AM to 4 PM SUN HOSPITAL POSTING MON TUE WED THU TUTORIALS at the College

Case scenario- Acute abdomen TUTORIALS on THURSDAYS at ALMAAREFA COLLEGE (Semester 161) DAY & DATE   Tutorial 8-9.40 AM BREAK 9.40- 10AM TUORIAL 10- 12 AM PRAYER 11.40. 1 PM TUTORIAL 1 PM- 4 PM THURSDAY 22-12-16 Case scenario- Acute abdomen Dr. Akeely Interpretation of common imaging studies Prof Alam Case scenario- Breast lump 29-12-16 Case scenario: Complications of abdominal surgery Topic: Examples of laparoscopic Surgery procedures Prof. AlSaigh Case scenario: A trauma patient 05-01-17 Interpretation of common laboratory investigations Spot diagnosis Case scenario: Thyroid & other neck swellings Prof AlSaigh 12-01-17 Case presentation by students Prof Alam/Prof AlSaigh

Sixth (6th) week- Examinations MCQ Case scenario OSCE Clinical examination

Marks distribution Mid-Block examination- 30 Marks Case presentation (5) + logbook (5)- 10 Marks Log book evaluation- attendance, h/e of pts., case presentation, skills attended/participated & tutor signature End Block examination 60 Marks

EXAMINATIONS MID-BLOCK EXAMINATION (1st Jan. 2017) MCQ : 45 questions - 15 Marks Slide Show- 5 slides 10 Marks (Each slide 2 marks) History taking 5 Marks (Volunteer/ SP) 2. END BLOCK EXAMINATION (6th week) MCQ: 30 questions 10 Marks Case scenarios: 2cases 10 Marks (Case slides & questions) OSCE: 5 stations 20 Marks ( X-ray, lab results, specimens, instruments, skill procedures) Clinical examination: 20 marks (Wednesday)- Real patients

Thank you!