Surgery: Assessment, Resuscitation and Operative Principles
Core concepts
Surgical questions test prioritisation under time pressure. Begin with resuscitation and assessment: airway, breathing, circulation, then focused history and examination. Understand shock physiology and the classic patterns of hypovolaemic, septic, cardiogenic and obstructive shock. Learn the acute abdomen framework - peritonitis, obstruction, perforation, haemorrhage, ischaemia - and the conditions that mandate urgent operation versus observation. Trauma teaching follows a predictable sequence: catastrophic haemorrhage control, airway, breathing, circulation, disability, exposure, with early imaging decisions. Know the principles of wound healing, sutures, and the timing of surgery in contaminated fields.
Traps
Examiners love the patient who is 'stable' but deteriorating; the correct answer is usually reassessment rather than reassurance. Distinguish investigation from intervention. Be careful with analgesia in undifferentiated abdominal pain - modern practice supports early analgesia, and questions that penalise it are outdated. Watch for the difference between a diagnostic and a therapeutic procedure, and for contraindications hidden in the stem, such as anticoagulation or pregnancy.
Rule of thumb
In any surgical emergency, treat the greatest threat to life first; physiology before anatomy. If the patient is unstable, the operating theatre is often the diagnostic tool.
Worked example
A young man with blunt abdominal trauma is tachycardic and hypotensive despite two litres of crystalloid, with a positive FAST scan. The answer is not CT - it is urgent laparotomy, because haemodynamic instability with free fluid after trauma means ongoing haemorrhage.