The GSSE syllabus

The syllabus of Core Surgical Anatomy can be found in the following document Core Surgical Anatomy syllabus (PDF 137.21KB).

• Structure of DNA and RNA, the cell cycle, the generation of genetic abnormalities
• Mendelian genetics
• Glytogeneties including basics of laboratory techniques for detection of cytogenetic abnormalities
• Specific conditions are examinable insofar as they illustrate important principles or are common or important disorders.

This part of the syllabus concentrates on understanding factors in the aetiology, pathogenesis, epidemiology, aspects of investigation and natural history of common diseases. The syllabus and the examination emphasise factors common to basic mechanisms of disease, recognising passive (essentially degenerative), reactive and neoplastic phenomena.

• General pathological phenomena include cell injury, adaptation and death, degenerations including atherosclerosis, pigmentation and calculus formation, alterations of growth, differentiation and function of cells and of age.
• Tissue response to injury includes the adaptive reactions of the body to injury.
• Knowledge expected includes an understanding of important morphological manifestations, pathophysiology of important disease states (e.g. major organ failure either single or combined, shock, sepsis, disseminated intravascular coagulation), biochemical mechanisms and manifestations where these factors are important in the understanding of pathogenesis, natural history diagnosis and treatment.

• Basic immunology including:
  • non-specific defence mechanisms, the complement system, the major histocompatibility complex
  • the cells of the immune system, their functions, their interactions, cell subsets, cell surface markers and receptors structure, function, genetics of secretory products of cells involved in the immune response including immunoglobulins, interleukins, various other factors activation and control of the normal immune response.
• Immunity infection including bacteria, viruses, fungi and protozoa.
• Abnormal immunological responses including hypersensitivity, autoimmune disorders and immunodeficiency disorders.
• Transplantation immunology.
• Diagnostic immunology including the basic principles (not detailed) of commonly used immunological tests, their applications and their limitations.

The microbial flora of the body and its role in disease

• Pathogenesis of infection - host defence mechanisms and microbial virulence
• Surgically relevant bacterial, viral, fungal and parasitic infections:
  • infection following surgery, for example, wound infection, septicaemia
  • infections with surgical implications, for example peritonitis, anaerobic soft tissue infections, AIDS
• Antimicrobial agents and their scientific use in the therapy and prevention (prophylaxis) of infection
• Sterilisation and disinfection
• Laboratory medicine aspects of infectious diseases, for example, principles behind blood culture techniques, interpretation of gram stains, antimicrobial susceptibility techniques.

Understanding neoplasia with specific detailed emphasis on:

• its cells and tissues of origin and components
• reproductive, growth (proliferative) patterns and host interaction
• mechanisms of invasion and metastasis
• molecular biological, genetic and inherited characteristics
• geographic racial and cultural (population) factors
• mechanisms and types of chemical physical and microbial carcinogenesis
• distinctive pathological (macroscopic, histological and immunochemical) features which aid diagnosis
• the application of 1-7 to common cancers in children and adults
• the application of 1-8 to important basic aspects of therapy.

This section is concerned predominantly with the principles of pathology particularly as applied to surgery in general.

With respect to the pathology syllabus:

• candidates should demonstrate an understanding of the general pathological mechanisms (degenerative, reactive and neoplastic) underlying common disease. This will include a knowledge of aetiology, pathogenesis, epidemiology, investigation and natural history: it will also include how these may be modified by the appropriate use of therapeutic agents; and, molecular biological, genetic and statistical aspects together with basic clinical decision analysis
• common and important issues in systemic pathology are examinable insofar as:
  • a given lesion exemplifies a basic pathological process, for example, anaphylaxis as an example of hypersensitivity reactions, myocardial infarction in atherosclerosis, colorectal carcinoma as an example of neoplasia, or
  • disorders of a given system are likely to be encountered in surgical practice, for example, post-operative pneumonia
• knowledge of laboratory medicine should be such as to enable candidates to make the optimum use of diagnostic services. Technical minutiae are not required.
• candidates should be able to identify:
  • the more common pathological processes from photographs of gross specimens and
  • the histopathological features of basic processes from photomicrographs
• familiarity with disease of animals is required only when knowledge of the animal disease is essential for the understanding of human pathology, for example, infestation of dogs with tape worm (Eehinococeus granulosus)
• in occasional circumstances material in the prescribed textbooks may conflict with widely held current viewpoints, or with each other. This will be taken into account when questions are constructed.

This will be a consideration of major therapeutic areas and major drug groups. The approach is to use basic pharmacological principles of pharmacodynamics and pharmacokinetics, and present much of the information as a mini pharmacopoeia.

The pharmacodmamics includes the mechanism of action of a drug, particularly where it may be important in understanding its use and/or its side-effects, whereas the pharmacokinetics include factors such as bioavailability (particularly to emphasise difference in routes of administration), plasma protein finding, clearance (metabolism if relevant) etc. The "take-home" message is to demonstrate the reason for dosage and dosing schedules, the effect of disease states on drugs, the effect of the drug on the patient, and potential clinically relevant drug interactions.

Drugs will be covered within disease topics, not as isolated entities.

Topics to be addressed:

Cardiovascular

• antihypertensives (including diuretics)
• antianginals, antiarrhythmics
• antifailure
• lipid lowering drugs
• treatment of shock (critical care).

Respiratory

• asthma, chronic obstructive airways disease

Endocrine

• corticosteroids (including Addisonian crisis)
• oestrogens ("the pill")
• thyroid
• Danazol, Bromocriptine, Tamoxifen
• diabetes mellitus and insulin
• desmopression.

Gastrointestinal tract

• antiulcer therapy (for example, H2 antagonists)
• antidiarrhoel, antiemetics, laxatives.

Central Nervous System

• opiates including palliative care
• minor and major tranquillisers
• anticonvulsants
• anaesthetics
• muscle relaxants
• local anaesthetics
• alcohol, tobacco
• chronic withdrawal and addiction.

Haemopoietic

• anticlotting (heparin, warfarin)
• streptokinase, rtPA
• Erythropoietin.

Oncology/immuno-suppression, transplantation

• cytotoxics, Tamoxifen

Miscellaneous

• anti-inflammatories
• stone dissolution (biliary).

Antibiotics

• This area is covered in Microbiology/Pathology. Emphasis is on possible drug interactions, clearance (liver and renal failure, probenieid), bioavailability e.g. tetracyclines and absorption.

Addition of special cases, for example, neonates, paediatric, pregnancy, ageing

Haematology and transfusion

• the origin and differentiation of haematopoietic cells
• anaemias of acute and chronic blood loss
• types and mechanisms of haemolysis
• anaemias caused by substrate deficiency
• bleeding disorders
• origin differentiation and proliferations of white cells particularly lymphomas.

Statistics

• statistical analysis of data including the principles of commonly used parametric and non parametric statistical tests
• clinical decision making
• principles of population statistics
• design and interpretation of clinical trials.

The physiology syllabus highlights aspects of human physiology as it is applicable to all surgical specialties. The candidate is expected to be competent in all these areas no matter where his/her particular interest may be directed.

It is expected that the candidate will have a clear understanding of normal human physiology and recognise how this may be altered by pathological processes, surgery or anaesthesia. Correlation between physiological changes and physical signs or symptoms elicited in patients should be clearly understood. For example, understanding of the physiological changes that:

• ensue in a patient following prolonged vomiting or diarrhoea,
• occur in renal function after surgery, or
• prevail in a patient with a duodenal ulcer.

The syllabus for Physiology can be found in the following document - Physiology Syllabus (PDF 182.88KB).