Surgery
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SNI SURGERY / PUBLIC SAMPLE

Understand the case.

Work through each scenario and answer its questions, one clinical decision at a time.

2 topicsPage 1 of 1
THEORY / Surgical principles

Surgical site infection

SCENARIO 01

A 50-year-old male was operated for embolism in right femoral artery on 5th post-operative day, He developed purulent discharge from the wound associated with high grate fever.

1. What is Surgical Site Infection (SSI)?

  • An infection involving an operative incision or a deeper space/organ related to surgery.
  • It may cause purulent discharge, increasing pain, erythema, wound separation, fever or systemic illness.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 8 · Principles of surgery · row 2

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

2. Which are the factors which contribute to SSI?

  • Patient factors: diabetes, smoking, obesity, malnutrition and immunosuppression.
  • Procedure factors: contamination, devitalised tissue, haematoma, foreign material, prolonged surgery and poor tissue perfusion.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 8 · Principles of surgery · row 2

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

3. How will you manage this patient?

  • Assess for sepsis and the depth of infection; obtain appropriate cultures.
  • Drain pus, remove devitalised tissue and achieve source control.
  • Use antibiotics when cellulitis, systemic infection or deeper infection is present, guided by local policy and culture results.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 8 · Principles of surgery · row 2

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

Practise this system
THEORY / Surgical principles

Wounds, healing and scars

SCENARIO 01

A 25-year-old female, patient undergoes repair of sharp wound over her forearm.

1. Steps of wound healing?

  • Haemostasis, inflammation, proliferation with granulation/epithelialisation, then collagen remodelling.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 8 · Principles of surgery · row 7

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

2. Define primary, secondary and delayed primary repair.

  • Primary closure: wound edges are approximated soon after assessment and cleaning.
  • Delayed primary closure: initially leave a contaminated wound open, then close once clean and suitable.
  • Secondary intention: an open wound heals by granulation, contraction and epithelialisation.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 8 · Principles of surgery · row 7

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

3. Enumerate differences between keloid and hypertrophic scar?

  • A hypertrophic scar remains within the original wound and may regress.
  • A keloid extends beyond the original wound margins, tends to persist and may recur after excision.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 8 · Principles of surgery · row 7

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

Practise this system
SCENARIO 02

A 65-year-old man sustains a large contaminated laceration of the right leg at a construction site.

1. Steps of treatment

  • Assess circulation, wound depth, contamination and neurovascular injury.
  • Give analgesia, irrigate and debride devitalised material; assess tetanus status and antibiotic indications.
  • Choose primary closure, delayed closure or secondary healing according to contamination and tissue viability.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 52

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

2. Factors affecting wound healing.

  • Local: blood supply, infection, foreign material, tissue tension and necrosis.
  • Systemic: diabetes, smoking, poor nutrition, steroid use, immunosuppression and anaemia.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 52

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

3. Factors which may cause his wound to get infected.

  • Soil contamination, retained foreign material, delayed presentation, devitalised tissue and poor perfusion.
  • Diabetes and impaired host immunity further increase infection risk.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 52

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

Practise this system
SCENARIO 03

A 25-year-old man sustains a lacerated wound of the left leg in a road traffic collision.

1. Classify wounds

  • By contamination: clean, clean-contaminated, contaminated and dirty/infected surgical wounds.
  • Traumatic wounds can additionally be described as incised, lacerated, puncture, crush or avulsion injuries.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 57

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

2. Phases of wound healing

  • Haemostasis → inflammation → proliferation/granulation and epithelialisation → remodelling.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 57

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

3. Difference between keloid and hypertrophic scar.

  • Hypertrophic scars stay within the original wound and may regress.
  • Keloids extend beyond the wound and are more persistent and recurrent.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 57

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

4. Adverse factors that affect wound healing.

  • Poor perfusion, infection, necrosis, foreign material and tension.
  • Smoking, diabetes, malnutrition, steroids and immunosuppression.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 57

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

5. What factors may cause his wound to get infected.

  • Contamination, devitalised tissue, haematoma, retained foreign material and delayed cleaning.
  • Patient comorbidity and poor aseptic practice may add risk.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 57

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

6. Management of wound

  • Assess the injury and neurovascular status; control bleeding and provide analgesia.
  • Irrigate and remove devitalised material; assess tetanus and antibiotics.
  • Close only when appropriate and arrange wound review with advice on infection or vascular warning signs.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 57

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

Practise this system
SCENARIO 04

A four-year-old boy presents one hour after sustaining a 9 cm arm laceration from falling through a glass door. He is haemodynamically stable with no other evident injury.

1. Classify wounds

  • By contamination: clean, clean-contaminated, contaminated and dirty/infected surgical wounds.
  • Traumatic wounds can additionally be described as incised, lacerated, puncture, crush or avulsion injuries.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 58

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

2. Phases of wound healing

  • Haemostasis → inflammation → proliferation/granulation and epithelialisation → remodelling.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 58

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

3. Difference between keloid and hypertrophic scar.

  • Hypertrophic scars stay within the original wound and may regress.
  • Keloids extend beyond the wound and are more persistent and recurrent.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 58

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

4. Adverse factors that affect wound healing.

  • Poor perfusion, infection, necrosis, foreign material and tension.
  • Smoking, diabetes, malnutrition, steroids and immunosuppression.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 58

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

5. What factors may cause his wound to get infected.

  • Contamination, devitalised tissue, haematoma, retained foreign material and delayed cleaning.
  • Patient comorbidity and poor aseptic practice may add risk.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 58

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

6. Management of wound

  • Assess the injury and neurovascular status; control bleeding and provide analgesia.
  • Irrigate and remove devitalised material; assess tetanus and antibiotics.
  • Close only when appropriate and arrange wound review with advice on infection or vascular warning signs.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 10 · Principles of surgery · row 58

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

Practise this system
SCENARIO 05

Explain the methods of wound closure and healing.

1. Primary repair

  • Immediate approximation of suitable clean wound edges after adequate assessment, irrigation and debridement.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 11 · Principles of surgery · row 66

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

2. Delayed primary repair

  • Leave the wound open initially; close later once contamination/infection risk is controlled and the tissue is viable.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 11 · Principles of surgery · row 66

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

3. Secondary repair

  • Allow an open wound to heal through granulation, contraction and epithelialisation; some wounds later need reconstruction.
References & source

SNI source: Surgery SNI 2nd edition print version.pdf · PDF page 11 · Principles of surgery · row 66

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

Practise this system
SCENARIO 06

A 25-year-old woman undergoes primary repair of a sharp forehead wound.

1. Describe the steps of wound healing.

  • Haemostasis, inflammation, proliferation/granulation and epithelialisation, then remodelling.
References & source

SNI source: CamScanner 20-10-2026 21.38.pdf · PDF page 5 · Q7

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

2. Define primary repair, delayed primary repair and secondary repair.

  • Primary repair closes suitable wound edges promptly.
  • Delayed primary repair closes after an initial period of open management once safe.
  • Secondary healing occurs by granulation, contraction and epithelialisation of an open wound.
References & source

SNI source: CamScanner 20-10-2026 21.38.pdf · PDF page 5 · Q7

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

3. Enumerate differences between keloid and hypertrophic scar.

  • Hypertrophic scar stays within the original wound and may regress.
  • Keloid extends beyond wound boundaries, persists and has greater recurrence risk after excision.
References & source

SNI source: CamScanner 20-10-2026 21.38.pdf · PDF page 5 · Q7

Bailey & Love links locate relevant chapters in the 28th edition. Page numbers are omitted where the textbook pagination has not been verified.

Practise this system

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For undergraduate revision. Management decisions should follow current clinical guidance and local practice.