Surgery and Procedural Skills
Core concepts
Procedural questions test informed consent, sterile technique, local anesthesia, and recognition of complications. Know the steps of common office procedures: incision and drainage, laceration repair, joint injection, and skin biopsy. Understand wound healing phases and factors that impair healing (diabetes, steroids, smoking, ischemia). Know suture selection and timing of removal by site. Recognize surgical emergencies: appendicitis, cholecystitis, bowel obstruction, and testicular torsion (a true emergency). Understand perioperative risk assessment and antibiotic prophylaxis indications.
Traps
- Missing testicular torsion-time is testicle; immediate urology referral and ultrasound without delay.
- Confusing cellulitis (treated medically) with abscess (requires drainage).
- Forgetting tetanus prophylaxis in contaminated wounds.
- Choosing the wrong anesthesia or failing to document consent and aftercare.
Worked example / rule of thumb
A fluctuant, tender skin abscess: incision and drainage is the primary treatment; antibiotics are adjunctive for systemic signs or high-risk patients. Rule of thumb: if it fluctuates, drain it.
Wound care
Irrigate, remove debris, approximate edges, and provide wound care instructions. Suture removal: face 4–5 days, scalp 7–10, trunk/extremities 10–14, joints 14.