Surgery and Surgical Specialties
Core concepts
Surgical questions emphasize preoperative assessment, the acute abdomen, wound healing, and postoperative complications. Know the differential of right lower quadrant pain (appendicitis, mesenteric adenitis, ovarian pathology, ureteral stone), the signs of peritonitis (rigidity, rebound, absent bowel sounds), and the classic timing of postoperative complications: atelectasis and bleeding early, infection around days 3–7, anastomotic leak days 5–8, and wound dehiscence later. Understand hernia types, bowel obstruction (adhesions, strangulation risk), and the principles of damage-control surgery in trauma.
Common traps
The exam frequently asks which imaging first. In a stable patient with suspected appendicitis, ultrasound is often first in younger patients and CT in adults; in unstable trauma, bedside FAST precedes CT. Distinguish mechanical from paralytic ileus (mechanical has hyperactive, high-pitched sounds early; ileus has absent sounds and generalized distension). Watch for questions confusing cholecystitis (Murphy sign, right upper quadrant) with cholangitis (Charcot triad: fever, jaundice, right upper quadrant pain).
Worked example
A 45-year-old with 2 days of periumbilical pain migrating to the right lower quadrant, fever, and leukocytosis. Rule of thumb: migration of pain + localized peritoneal signs = appendicitis until proven otherwise; management is appendectomy (or antibiotics in selected uncomplicated cases per local protocol), with imaging to confirm when diagnosis is unclear.
Rule of thumb
In trauma, treat the greatest threat first (airway, tension pneumothorax, hemorrhage); in acute abdomen, decide operate vs observe based on peritonitis and hemodynamic stability.