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Whether you exercise a desire to experience surgery abroad during your student elective or whether you want to take the opportunity to enhance your career aspirations in far-flung regions, knowledge of common surgi­cal presentations of tropical disease is a prerequisite. Moreover, with the ability conferred by modern jet travel to translocate to almost any area of the globe within 48h, you may well encounter these conditions in your local general hospital clinic or emergency department, in visitors to the country or in travellers returning home from foreign excursions. This chapter tests you on your knowledge of presentations, investi­gations, and management of diseases such as malaria, schistosomiasis, amoebiasis, and filariasis, conditions native to a variety of geographical locations. Some diseases such as hydatid still remain endemic in regions closer to the UK. A sound understanding of parasitic life cycles, modes of exposure to, and manifestations of infection, and principles of treatment, will help you to diagnose and manage these conditions whether they are encountered unexpectedly, or prevalent in your geographical location.

Understanding that children are not small adults, and that they come in different sizes and stages of development, is fundamental to paediatric surgery. Knowledge of a child’s weight is crucial when considering fluid and medication administration. Moreover, babies have immature physiology and less functional reserve compared to older children. Understanding basic embryology will unravel some of the mysteries of developmental pathology encoun­tered by the paediatric surgeon, such as oesophageal atresia, malrotation of the gut, annular pancreas, and maldescent of the testis. The paediatric surgeon deals with some of the same surgical condi­tions that affect adults, but even management of a common condition such as inguinal hernia, has different therapeutic implications in children and adults. Paediatric surgery demands gentle tissue handling and deli­cate technique. Good communication skills are a prerequisite for dealing with the distraught or ill child and anxious parents, and the surgeon often retains a clinical interest in his or her patient, well into young adulthood. This chapter will test your knowledge of principles of surgical manage­ment of sick children and your understanding of presentations of some of the more commonplace conditions encountered by surgeons in this demanding, yet rewarding, discipline.

When the student contemplates potential causes of urinary tract obstruction, considering the anatomy of the drainage system from renal pelvis to urethral meatus and appreciation of potential causes of block­age will provide a useful diagnostic screen and will help one to review the breadth of conditions which may affect the renal tract. These include extrinsic compression, (for instance, due to retroperitoneal fibrosis or prostatic hypertrophy), mural involvement (infection, inflammation and transitional cell carcinoma), or luminal obstruction, (blood clot, stone, or valve). A firm grasp of appropriate investigations for urinary tract disease will aid diagnostic accuracy. Urological surgery encompasses various aspects of neoplasia and developmental conditions. This chapter will test your knowledge of the presentation, diagnosis, management, and pathology of common urological malignancies including renal adenocarcinoma, transitional cell tumours, testicular tumours, and carcinoma of the prostate. Urological conditions often occur in patients who may have other co-morbidities. Understanding the causes, investigation, and management of renal failure, appreciating the significance of haematuria, and knowing how to deal with an urological emergency of acute urinary obstruction will add to the medical student’s or trainee surgeon’s breadth of compe­tence in general surgical practice.

Management of the cardiothoracic patient is diagnostically and techni­cally demanding. Cardiothoracic surgery comprises cardiac and thoracic components. Whilst overlap exists between treatment of pulmonary conditions including lung neoplasia, infection and ventilatory dysfunction, and treatment of cardiac disease, progressively surgeons tend to special­ize in one area or the other. Boundaries between cardiac surgery and interventional cardiology are also diminishing as new endovascular interventions—for instance, in coronary artery angioplasty, stenting, and valve replacement—achieve growing therapeutic prominence and compete with open surgical procedures. A firm grasp of cardiopulmonary physiology underpins understanding of cardiovascular function and of the pathologies affecting these systems. This chapter will test you on aspects of pulmonary pathology, cardiovas­cular physiology, and on ischaemic heart disease and valvular dysfunc­tion. This should help you to revise key aspects in this demanding and rapidly evolving area of surgery.