General Surgery: Principles, Assessment and Safe Practice
Core concepts
The General Surgery component tests principles more than operative detail: perioperative risk assessment, wound healing, fluid and electrolyte balance, sepsis, and the recognition of the acute abdomen. Be confident with the surgical sieve (congenital, inflammatory, neoplastic, traumatic, vascular, metabolic) and with shock physiology. Understand the phases of wound healing (haemostasis, inflammation, proliferation, remodelling) and factors that impair it (diabetes, steroids, ischaemia, infection).
Traps
Questions often present a stable-looking patient with a red flag (rigid abdomen, absent bowel sounds, rising lactate) and ask for the next step; the answer is usually resuscitation and urgent senior review/surgical referral, not a scan in isolation. Another trap is confusing obstructive vs paralytic ileus (obstruction: colicky pain, vomiting, tinkling bowel sounds; ileus: distension, absent sounds, recent surgery).
Worked example
A patient with a perforated viscus has tachycardia, hypotension, and board-like rigidity. The priority is ABCDE resuscitation with IV fluids, analgesia, and broad-spectrum antibiotics, followed by urgent surgical assessment - not waiting for CT in an unstable patient. The trap is choosing imaging before stabilisation.
Rule of thumb
Resuscitate before you investigate; investigate before you operate - unless the patient is unstable. Always state the safest next step explicitly.