WEST AFRICAN SURGICAL TRAINING · PRIMARIES CASE CASCADES
Case Cascades — Surgery Primaries
One patient. Chained decisions from applied anatomy, physiology, pathology, pharmacology and microbiology through to the operative choice each principle drives. Every step is reasoned and referenced. Bailey & Love, Sabiston, Last's, Ganong's, Katzung and Robbins-anchored — examinable in Surgery Primaries and MRCS Part A.
Applied Anatomy 3 cases
APPLIED ANATOMY · PRIMARIES SURGERY
Inguinal canal anatomy → open hernia repair — 32M
Mr K, 32-year-old lorry driver, elective open right inguinal hernia repair. Preoperative diagnosis was clinically an indirect hernia. He is fit, non-smoker, BMI 24. Local + sedation planned. Skin marked, patient supine.
Bailey & Love 28e Ch 71 · Last's Anatomy 12e · Sabiston 21e Ch 43 · EHS 2018 groin hernia
Start cascade →
APPLIED ANATOMY · PRIMARIES SURGERY
Femoral triangle anatomy → femoral hernia repair — 68F
Mrs A, 68-year-old market trader, has a small painless right groin lump present for six months, below and lateral to the pubic tubercle. Ultrasound confirms a femoral hernia. Elective low-approach mesh repair planned und…
Bailey & Love 28e Ch 71 · Last's Anatomy 12e · Sabiston 21e Ch 43
Start cascade →
APPLIED ANATOMY · PRIMARIES SURGERY
Brachial plexus → nerve-injury pattern after motorcycle RTA
Mr K, 34-year-old boda-boda rider, was thrown from his bike with the head forced away from the shoulder. He has an adducted, internally-rotated right arm with the forearm pronated and elbow extended. Sensation is reduced…
Bailey & Love 28e Ch 34 · Last's Anatomy 12e · Sabiston 21e Ch 68
Start cascade →
Applied Physiology 3 cases
APPLIED PHYSIOLOGY · PRIMARIES SURGERY
Haemorrhagic shock physiology — 24M splenic injury
Mr Y, 24-year-old motorcyclist, high-speed collision. He arrives with a suspected splenic injury: BP 92/62, HR 128, RR 26, cool peripheries, confused (GCS 13), urine output 15 ml/h. Estimated blood loss so far ~1.5 L.
Bailey & Love 28e Ch 4 · Ganong's 26e Ch 33 · Sabiston 21e Ch 22 · ATLS 10e
Start cascade →
APPLIED PHYSIOLOGY · PRIMARIES SURGERY
Cardiac cycle → pre-op cardiac reserve — 68M AAA repair
Mr T, 68-year-old retired driver, elective infrarenal AAA repair booked. Ejection fraction 42%, previous NSTEMI, on beta-blocker + statin + aspirin. Exercise tolerance 4 METs. Non-diabetic.
Bailey & Love 28e Ch 4 · Ganong's 26e Ch 30 · Sabiston 21e Ch 25
Start cascade →
APPLIED PHYSIOLOGY · PRIMARIES SURGERY
Respiratory mechanics → post-op atelectasis — 62F
Mrs O, 62-year-old smoker, day-2 post open cholecystectomy. SpO₂ 88% on room air, RR 24, shallow breathing, right basal crackles + reduced expansion. CXR: right basal atelectasis. Not febrile.
Bailey & Love 28e Ch 6 · Ganong's 26e Ch 34–36 · West's Respiratory Physiology 10e
Start cascade →
Applied Pathology 1 case
Applied Pharmacology 1 case
Applied Microbiology 2 cases
APPLIED MICROBIOLOGY · PRIMARIES SURGERY
Sterilisation & asepsis biology — new theatre setup
A new theatre suite is being commissioned. You must select processes for reusable metal instruments, flexible endoscopes, single-use devices, blood-pressure cuffs, and the theatre environment itself.
Bailey & Love 28e Ch 5 · WHO 2018 SSI · Spaulding classification · CJD guidance
Start cascade →
APPLIED MICROBIOLOGY · PRIMARIES SURGERY
Sterilisation Wave 2 → endoscope reprocessing outbreak audit
Six patients over four months developed CRE bloodstream infection after ERCP performed with the same duodenoscope. Routine automated endoscope reprocessing (AER) with high-level disinfection was documented on each occasi…
Bailey & Love 28e Ch 5 · WHO 2018 SSI · FDA duodenoscope guidance · Rutala & Weber CDC HICPAC
Start cascade →
Why case cascades?
Multiple-choice banks test recall. Cascades test judgement — the decision-making thread that connects triage to theatre to post-op. In the exam you'll be asked "what next?" over and over. This is how you rehearse for that.
Every step is grounded in Bailey & Love 28th edition, Sabiston 21st, WSES / ERAS / NELA guidelines, and Cochrane-level evidence where it exists. Where West African practice diverges from Western textbooks (biological mesh availability, transfer distances, unit capacity), the cascade calls it out.