Surgery including Dentistry: Assessment, Complications and Emergencies
What you must know
Surgical questions test preoperative assessment, operative principles and postoperative complications. Understand the physiology of the stress response, wound healing and sepsis. Know how to assess an acute abdomen, the features of obstruction, perforation and peritonitis, and the principles of fluid resuscitation. Common examinable topics include appendicitis, cholecystitis, hernia, bowel obstruction, trauma assessment and wound management. Dental content overlaps with surgery through facial swelling, odontogenic infection, trauma to teeth and the spread of infection into fascial spaces.
Traps and discriminations
- Sequence in trauma. Follow airway, breathing, circulation in order; a question may tempt you to treat a limb injury first.
- Obstruction versus ileus. Both cause distension and vomiting; the history of previous surgery and the character of bowel sounds help.
- Timing of complications. Early wound problems are usually haematoma or infection; late ones include incisional hernia and adhesion obstruction.
- Dental emergencies. A facial swelling with trismus and dysphagia suggests a spreading odontogenic infection requiring urgent drainage and antibiotics, not just analgesia.
- Antibiotic stewardship. Prophylaxis is not treatment; know when antibiotics are indicated versus when source control is the priority.
Worked example: the rule of source control
A patient with a perianal abscess and fever is prescribed antibiotics alone. Rule of thumb: in a collection, antibiotics do not penetrate pus effectively, so drainage is the definitive treatment and antibiotics are adjunctive. The exam answer that omits drainage is almost always wrong.
Practical reasoning
When a stem describes a postoperative patient with tachycardia, tachypnoea and oliguria, think hypovolaemia and sepsis before assuming cardiac causes. Calculate fluid deficits and review the operation note. For dental trauma, remember that a knocked-out permanent tooth is handled differently from a primary tooth, and time to replantation matters.