Surgery: Assessment, Resuscitation, and Operative Decisions
Surgical questions test prioritization under uncertainty. Master the ABCDE primary survey, the difference between blunt and penetrating trauma, and the principle that unstable patients go to the operating room while stable patients get imaging. In acute abdomen, localize pain and correlate with peritoneal signs: generalized rigidity suggests perforation or peritonitis and demands urgent laparotomy. Know the classic presentations of appendicitis (migration of pain to the right lower quadrant, rebound tenderness), cholecystitis (right upper quadrant pain with Murphy sign), and small bowel obstruction (colicky pain, vomiting, distension, absolute constipation).
Traps
Examiners love the "stable versus unstable" pivot, and the distractor that recommends CT in a hemodynamically unstable patient. Another trap is confusing the timing of antibiotic prophylaxis (within one hour before incision) with treatment dosing.
Worked example
A young man with periumbilical pain migrating to the right lower quadrant, fever, and leukocytosis: the diagnosis is acute appendicitis. If the question adds generalized peritonitis and hypotension, the answer shifts from imaging to resuscitation and emergency laparotomy. Use the rule: resuscitate, then diagnose, then operate - but never delay source control in the unstable patient.
Postoperative principles
Remember wound classification and the risk of surgical site infection, and the value of early mobilization and thromboprophylaxis. For any postoperative fever, work through the timeline: atelectasis early, then catheter-associated infection, then deep vein thrombosis, then abscess.