General Surgery Principles and Perioperative Care
Core concepts
Understand wound healing phases (hemostasis, inflammation, proliferation, remodeling), the difference between primary, delayed primary, and secondary intention, and factors that impair healing (ischemia, infection, steroids, diabetes, malnutrition, radiation). Know surgical asepsis, sterile field discipline, and the classification of wounds (clean, clean-contaminated, contaminated, dirty) because prophylaxis and infection risk follow from it. Master perioperative risk assessment: cardiac risk indices, functional capacity in metabolic equivalents, pulmonary risk, VTE risk, and glycemic control. Fluid and electrolyte management, perioperative nutrition, and enhanced recovery principles (early feeding, opioid-sparing analgesia, early ambulation) are frequent topics.
Traps in questions
Questions often test the timing of antibiotic prophylaxis (within 60 minutes of incision, redosing for long cases) and whether therapeutic antibiotics differ from prophylaxis. Another trap is confusing risk factors for poor wound healing with risk factors for surgical site infection. Distinguish perioperative beta-blockade continuation from initiation. Watch for questions that conflate malnutrition markers (albumin is a poor acute marker; prealbumin is affected by inflammation).
Worked rule of thumb
For any perioperative question, ask: what is the patient's physiologic reserve, what is the procedure's stress, and what modifiable factors exist? Example: a diabetic patient on steroids undergoing elective hernia repair has impaired healing and infection risk; optimize glucose, continue steroids with stress dosing, and consider delaying surgery if infection is present.
Exam strategy
Link each answer to a mechanism. If an option describes a practice without a physiologic rationale, it is often a distractor.