Surgery and Surgical Subspecialties
Core concepts
Surgical questions test structured assessment and safe decision-making: the ABCDE primary survey, shock classification (hypovolaemic, cardiogenic, distributive, obstructive), acute abdomen, complicated hernia, bowel obstruction and strangulation, appendicitis, wound classification, prophylactic antibiotics, burns, and postoperative complications such as atelectasis, wound infection, venous thromboembolism and anastomotic leak. Thyroid and breast questions emphasise anatomy and recognition of complications such as recurrent laryngeal nerve injury and hypocalcaemia.
Traps
Removing an impaled object; passing a nasogastric tube when a basal skull fracture is suspected; attributing hypotension after trauma to anything other than haemorrhage; starting vasopressors before volume resuscitation in haemorrhagic shock; and ordering imaging before resuscitation. A normal lactate does not exclude early shock, and a normal white cell count does not exclude appendicitis.
Worked example
A 70 kg man has 30% total body surface area burns. Parkland formula: 4 mL x 70 kg x 30 = 8400 mL over 24 hours, with half (4200 mL) in the first 8 hours measured from the time of the burn, not from arrival. Titrate the rate to urine output.
Rule of thumb
Treat life-threatening problems before limb-threatening ones, and reassess after every intervention. In trauma, hypotension means haemorrhage until proven otherwise; find the bleeding and stop it.