Surgery and Surgical Subspecialties
What candidates must know
Primary-care surgery is about recognising surgical disease, triaging urgency, and managing minor procedures safely. Understand the acute abdomen approach (history, peritonism, guarding, rigidity), the differential of right lower quadrant pain, and the red flags for bowel obstruction, appendicitis, cholecystitis, hernia and testicular torsion. Know when a lump needs urgent referral (breast, thyroid, soft tissue) using the "why now" features - rapid growth, pain, fixation, overlying skin change. Understand wound assessment, suture selection and timing, abscess drainage principles, and post-operative complication recognition (infection, dehiscence, DVT).
Traps in questions
- Testicular torsion is a time-critical emergency - do not wait for imaging if the clinical picture fits; refer immediately.
- Hernia with obstruction or strangulation (pain, vomiting, irreducible, tender) is a surgical emergency, not an elective referral.
- Peritonism (rebound, rigidity) overrides reassuring vital signs.
- Lump referral criteria: a fixed, hard, rapidly enlarging mass needs urgent assessment even if the patient feels well.
- Suture timing: contaminated wounds may need delayed primary closure rather than immediate suturing.
Rule of thumb
"Is this time-critical?" - torsion, strangulation, perforation and peritonitis are minutes-to-hours problems; the rest can follow routine referral pathways.
Worked example
A 16-year-old with sudden severe testicular pain and vomiting, no trauma. The diagnosis to exclude is testicular torsion; refer for immediate surgical assessment - analgesia does not change the urgency and ultrasound should not delay exploration.