Surgery is 15% of the Emirates Medical Residency Entrance Examination, across 160 blueprint topics. Try twelve questions from Axiota's EMREE pack, which has 923 cards on this section.
Pick an answer to start
Clinical Features · Colorectal and Abdominal Wall Surgery
What blood urea nitrogen to creatinine ratio strongly predicts an upper gastrointestinal bleeding source?
Show the full answer
Bleeding arising from the oesophagus, stomach or duodenum. Patients often present with haematemesis, coffee-ground vomiting, melaena, or haematochezia — maroon-coloured stool — if the haemorrhage is severe. The strongest predictors of an upper source are black stool, age under 50 and a blood urea nitrogen to creatinine ratio of 30 or more, since digested blood raises urea disproportionately.
Diagnoses & Investigations · Endocrine Surgery — Neck, Parathyroid and Adrenal
What parathyroid imaging finding is characteristic of tertiary hyperparathyroidism?
Show the full answer
By the biochemistry in context: a raised calcium with a raised parathyroid hormone — the primary pattern — but occurring in a patient with a history of long-standing secondary hyperparathyroidism from renal disease. The history is what separates it from primary disease, since the numbers alone do not. Imaging shows hyperplasia of all four glands rather than a single adenoma, which is why the operation differs.
Clinical Features · ENT II — Bleeding, Discharge, Blocked Sinuses and the One-Sided Deafness
Which physical examination finding directly distinguishes acute otitis externa from otitis media?
Show the full answer
Pain on moving the outer ear. Unlike other forms of ear infections, there is tenderness in the outer ear — the pain of acute external otitis is worsened when the outer ear is touched or pulled gently. It often presents with ear pain, swelling of the ear canal, and occasionally decreased hearing.
Fundamental Scientific Concepts · Eye and ENT: The Sight and Hearing You Cannot Wait On
What is the major modifiable risk factor for the progression of glaucoma?
Show the full answer
Increased pressure within the eye, known as intraocular pressure. Raised IOP damages the optic nerve, which is why lowering it is the target of every treatment.
Clinical Features · Gastroenterology — Ulcer, Reflux, Bowel, Pancreas and Liver
Which type of peptic ulcer typically causes pain about three hours after a meal and wakes the patient at night?
Show the full answer
Duodenal. With a duodenal ulcer the pain occurs about 3 hours after a meal and wakes the person from sleep — food buffers acid briefly, and pain returns once the stomach empties. With a gastric ulcer the pain may worsen with eating instead. The distinction is suggestive rather than diagnostic, but it is a favourite discriminator.
Clinical Features · Geriatrics — Confusion, Cognition, Falls and the Fractured Hip
Which physical examination finding is classic for a proximal femoral fracture after a fall?
Show the full answer
A proximal femoral fracture. The affected extremity is often shortened and externally rotated compared to the unaffected leg, and usually the person cannot walk — an elderly patient who sustained a low-energy fall and now has groin pain and is unable to bear weight is the typical presentation. Elderly patients tend to fall to the side rather than forward, so the lateral hip strikes the ground first.
Clinical Features · Upper GI and Hepatobiliary Surgery
Right upper quadrant pain that peaks at 1 hour and subsides completely within 5 hours is characteristic of which diagnosis?
Show the full answer
Biliary colic — symptomatic cholelithiasis, what patients consider a gallstone attack. The pain is sudden and severe in the right upper abdomen or epigastrium, typically peaks approximately 1 hour after onset and usually subsides completely within 5 hours. Complete resolution is what distinguishes it from cholecystitis, where pain lasts more than 6 hours and does not subside.
Diagnoses & Investigations · Internal Medicine I — Ketoacidosis, Leukaemia, Lung Cancer and the Cold Limb
Within what maximum time window should acute limb ischaemia be treated to prevent irreversible damage?
Show the full answer
Hours. Delayed treatment beyond 6 to 12 hours can result in permanent disability, amputation or death, and gangrene can occur suddenly and spread rapidly, so it should be treated within six hours of ischaemia. In a patient with otherwise no known risk factors, atrial fibrillation with embolism should be suspected — this is an embolus until proved otherwise, and the clock started when the pain did.
Clinical Features · Internal Medicine II — Childhood Tumours, Adrenal, Bone and the Reactive Joint
What is the peak age of incidence for Wilms tumour?
Show the full answer
Wilms tumour — nephroblastoma, a cancer of the kidneys that typically occurs in children, with a peak age of 3 to 4 years and most cases before the age of 10. It presents as a painless, palpable abdominal mass, with blood in the urine in about 20% of cases and high blood pressure in some. The mass is typically confined to one flank and does not cross the midline.
Which imaging modality is preferred when malignant spinal cord compression is suspected?
Show the full answer
Immediately, with MRI of the whole spine — X-rays may be used but MRI is preferred, and the whole spine is imaged because deposits are often at multiple levels. Once complete paralysis has been present for more than about 24 hours before treatment, the chances of useful recovery are greatly diminished. The imaging window and the treatment window are the same window.
Pharmacologic Therapies · Neurosurgery — Pressure, Tumours, Infection and the Compressed Nerve
Which medical therapy is used to acutely lower raised intracranial pressure in a head-injured patient with an intact blood-brain barrier?
Show the full answer
Osmotherapy. If there is an intact blood-brain barrier, osmotherapy — mannitol or hypertonic saline — may be used to decrease intracranial pressure. It is unclear whether mannitol or hypertonic saline is superior, or if they improve outcomes, so osmotherapy buys time for a definitive step rather than being the definitive step.
Clinical Features · Orthopaedics — Open Fractures, Bone Tumours, Birth Injuries and the Hip That Must Be Found Early
How does chondrosarcoma primarily differ from most other primary bone sarcomas in its patient population?
Show the full answer
By age. Chondrosarcoma is a bone sarcoma, a primary cancer composed of cells derived from transformed cells that produce cartilage, and unlike other primary bone sarcomas that mainly affect children and adolescents, it can present at any age. Often patients are not aware of the growing tumour until there is a noticeable lump or pain, so presentation is late.
Systemic inflammatory response, Surgical infection prevention, Principles of antibiotics use in surgical patients, Surgical Site Infections, Intra-Abdominal Infections, Infections of the Skin and Soft Tissue
Preoperative assessment
Preoperative evaluation, Risk assessment
Anaesthesia & Pain management
Local and regional anaesthesia, Patient's monitoring, Pain management
Post-operative care, Postoperative fever, DVT, Complications of common procedures
Breast
Mastalgia, Nipple discharge, Breast mass approach, Breast mass in pregnancy, Benign breast disorders proliferative and non-proliferative disease, breast abscess, mastitis, Breast cancer screening, Breast cancer
Thyroid and Parathyroid
Neck mass evaluation, Thyroid nodule approach, Surgery for hyperthyroidism, Thyroid cancer, Complications of thyroidectomy, Primary hyperparathyroidism, Secondary hyperparathyroidism, Tertiary hyperparathyroidism
Adrenal
Surgical hypertension, Incidental adrenal mass
Gastrointestinal System
GERD complications and surgery, Corrosive esophageal injury, Swallowing foreign body, Esophageal cancer, Upper GI bleeding, Peptic Ulcer Disease, Surgical management of Obesity, Lower GI bleeding, Bowel obstruction, Inflammatory Bowel Disease, Colon cancer screening, Colonic polyp, Colon cancer, Diverticular disease, PR bleeding, Anorectal conditions, Pilonidal sinus
Hand infections, Fingers injuries and amputations, Carpal tunnel syndrome, Upper limb nerve injuries evaluation, Cutaneous melanoma, Squamous cell carcinoma, Burn, Bed sore
Trauma
Initial assessment of trauma patient, Airway management, Life threatening injuries (Airway obstruction, tension pneumothorax, cardiac tamponade, Chest trauma, Shock, Abdominal trauma, Pelvic fracture, Head trauma, Spinal injuries, Musculoskeletal trauma, Trauma in extreme age, Triaging
Gastrointestinal Bleeding
Upper GI bleeding, causes and surgical management, Lower GI bleeding causes and surgical management
Specific organ trauma
Liver, Spleen, Kidney and retroperitoneum, Esophageal, gastric and bowel trauma, Damage control surgery
Surgical ICU
Abdominal compartment syndrome, Lung protective ventilation, Early and adequate nutrition, Restrictive blood transfusion, DVT and stress gastritis prophylaxis, Source control in septic patients