Surgery: Assessment, Indications, and Complications
Surgical questions test preoperative assessment, operative decision-making, and recognition of postoperative complications. Start with resuscitation status (ABCs), then the surgical problem: is this an emergency (perforation, ischemia, hemorrhage, strangulation) or can it be optimized? Understand the acute abdomen, hernia complications, biliary and pancreatic disease, bowel obstruction, and trauma priorities.
Concepts to master
- The acute abdomen: peritonitis signs, rigidity, absent bowel sounds, and when imaging (ultrasound vs. CT) is appropriate.
- Trauma: primary survey (ABCDE), focused assessment with sonography, and damage-control principles.
- Postoperative complications by timeline: immediate (hemorrhage, anastomotic leak), early (infection, ileus, DVT), late (adhesions, incisional hernia).
- Wound classification and antibiotic prophylaxis timing (within 60 minutes of incision).
- Fluid and nutritional support; recognizing sepsis and the need for source control.
Traps
Questions often present a patient who is "stable" but has a subtle sign of ischemia (pain out of proportion, lactate rise). Another classic trap is attributing postoperative tachycardia and fever to a benign cause when it signals leak or sepsis. Do not choose an operation that treats the symptom but ignores the underlying pathology (e.g., drainage without source control). Watch for contraindications framed as routine steps.
Worked rule of thumb
"Pain out of proportion to examination" plus rising lactate equals mesenteric ischemia until proven otherwise; proceed to CT angiography, not watchful waiting. For any postoperative fever, use the timeline: day 1–2 hemorrhage/atelectasis, day 3–5 pneumonia/urine, day 5–10 anastomotic leak/abscess, later DVT or drug fever.