Surgery
Scope
Surgery covers acute abdomen, trauma, wound management, surgical infection, perioperative care, and common elective procedures (hernia, cholelithiasis, appendicitis). Know the presentation and initial management of appendicitis, cholecystitis, pancreatitis, bowel obstruction, perforated ulcer, and hernia strangulation.
Key concepts
- Asepsis and antisepsis; sterilization principles.
- Wound classification (clean, clean-contaminated, contaminated, dirty) and timing of surgical debridement.
- Shock recognition and initial resuscitation; fluid and blood product principles.
- Perioperative risk assessment, prophylaxis (antibiotic, thromboprophylaxis), and postoperative complication recognition (wound infection, dehiscence, DVT, anastomotic leak).
- Principles of trauma care (ABCDE) and damage control.
Traps
Questions test the first step in an unstable patient - resuscitation before definitive surgery. Another trap is confusing the indication for conservative versus operative management, or misidentifying which sign is peritoneal (rigidity, rebound) versus nonspecific.
Rule of thumb
In acute abdomen, if there is peritonitis, perforation, strangulation, or hemodynamic instability, the patient needs urgent surgical evaluation and operative readiness - not observation. When in doubt, escalate.
Worked example
An elderly patient with a tender, irreducible, painful groin mass and vomiting: this suggests strangulated hernia. The correct answer is urgent surgical referral after resuscitation, not manual reduction attempts or outpatient follow-up, because strangulation risks bowel ischemia.