MD Emergency Medicine - Paper III

Emergency Surgical Specialties

1. SURGICAL EMERGENCIES

Acute Abdomen & GI

• Acute appendicitis
• Acute cholecystitis and biliary colic
• Bowel obstruction (small and large bowel)
• Perforated viscus / peritonitis
• Acute pancreatitis
• Mesenteric ischemia
• Hernias (incarcerated / strangulated)
• GI bleeding (upper and lower) - emergency surgical aspects
• Anorectal emergencies (abscess, fissure, thrombosed hemorrhoids)

Vascular Surgical Emergencies

• Acute limb ischemia
• Ruptured abdominal aortic aneurysm (AAA)
• Aortic dissection - surgical aspects
• Deep vein thrombosis complications

Genitourinary Surgical Emergencies

• Renal colic / ureteric stone
• Testicular torsion
• Priapism
• Urinary retention / acute urinary obstruction
• Paraphimosis / phimosis
• Fournier's gangrene

Skin & Soft Tissue

• Abscess - incision and drainage
• Necrotizing fasciitis
• Wound management - principles
• Tetanus prophylaxis

Breast

• Breast abscess

2. TRAUMA

Initial Evaluation & Resuscitation

• Primary and secondary survey (ATLS principles)
• Airway management in trauma
• Hemorrhage control and damage control resuscitation
• FAST (Focused Assessment with Sonography in Trauma)

Head & Spine Trauma

• Head injury - epidural, subdural, diffuse axonal injury
• Raised intracranial pressure management
• Spinal cord injuries - assessment and initial management
• Cervical spine clearance protocols

Chest Trauma

• Pneumothorax (tension, open, simple)
• Hemothorax
• Rib fractures / flail chest
• Cardiac tamponade
• Aortic injury / traumatic aortic transection
• Pulmonary contusion

Abdominal & Pelvic Trauma

• Blunt abdominal trauma - evaluation
• Splenic and hepatic injuries
• Pelvic fractures and hemorrhage control
• Urogenital trauma (bladder, urethra, kidney)

Vascular Trauma

• Penetrating trauma to neck, chest, abdomen
• Wound ballistics and forensics

Burns

• Burn assessment (Rule of Nines, Lund-Browder)
• Fluid resuscitation in burns (Parkland formula)
• Airway burns and inhalation injury
• Electrical and chemical burns

Special Populations in Trauma

• Pediatric trauma
• Geriatric trauma
• Trauma in pregnancy

Wound Care

• Wound ballistics
• Tetanus prophylaxis
• Compartment syndromes - acute and crush syndrome

3. ORTHOPEDIC EMERGENCIES

Traumatic Orthopedic Emergencies

• Initial evaluation and management of orthopedic injuries
• Fractures - general principles (open, closed, pathological)
• Dislocations - shoulder, hip, knee, elbow
• Fractures of specific regions:
  • Clavicle, humerus, forearm, wrist (Colles, scaphoid)
  • Femur (neck, shaft), tibia, fibula, ankle, foot
  • Spine fractures
  • Pelvic ring fractures
• Orthopedic devices and reconstruction in ED

Compartment Syndrome

• Diagnosis and emergency fasciotomy principles

Non-Traumatic Orthopedic Emergencies

• Acute osteomyelitis
• Acute septic arthritis
• Acute gout and crystal arthropathy
• Prosthesis-related emergencies (periprosthetic fracture, dislocation, infection)
• Acute back pain - red flag assessment
• Acute neck pain
• Acute shoulder pain
• Hand and wrist emergencies
• Neurovascular examination of extremities

4. OPHTHALMIC (EYE) EMERGENCIES

Red Eye

• Conjunctivitis (bacterial, viral, allergic)
• Acute angle-closure glaucoma
• Uveitis / iritis
• Episcleritis / scleritis

Ocular Trauma

• Foreign body (corneal, intraocular)
• Corneal abrasion
• Hyphema
• Blow-out fracture of orbit
• Chemical burns (acid and alkali) - irrigation
• Lid lacerations
• Ruptured globe

Visual Loss / Impairment

• Central retinal artery occlusion
• Central retinal vein occlusion
• Retinal detachment
• Vitreous hemorrhage
• Temporal arteritis (giant cell arteritis)

Orbital Emergencies

• Orbital cellulitis / preseptal vs. postseptal

Procedures in Ocular Emergencies

• Slit lamp examination
• Eye irrigation
• Intraocular pressure measurement
• Lateral canthotomy (emergency)

5. ENT (EAR, NOSE & THROAT) EMERGENCIES

Ear

• Acute suppurative otitis media
• Otitis externa
• Foreign bodies in ear
• Acute mastoiditis

Nose

• Epistaxis - anterior and posterior (management, packing techniques)
• Nasal bone fracture
• Nasal septal hematoma
• Acute sinusitis / rhinosinusitis
• Foreign bodies in nose

Throat / Oropharynx

• Acute tonsillitis / peritonsillar abscess
• Retropharyngeal and parapharyngeal abscess
• Acute epiglottitis
• Acute laryngitis / croup
• Foreign bodies in the airway and esophagus
• Ludwig's angina

Dental / Oral

• Orofacial pain - assessment
• Dental fractures (Ellis classification)
• Dental subluxation and avulsion (reimplantation protocols)
• Dental abscess

Complications

• Complications of airway devices
• Post-tonsillectomy bleeding

Summary Table

Note: Different universities (BLDE, MGM, Sri Siddhartha, etc.) may have minor variations in how they distribute subtopics within Paper III, but the NMC-notified 2024 framework clearly defines Paper III as "Emergency Surgical Specialties: Surgical emergencies, Trauma, Orthopedics, Eye, ENT."