Surgery
Surgery tests acute abdominal assessment, trauma resuscitation, perioperative risk, and common general-surgical conditions. Expect appendicitis, bowel obstruction, hernia, biliary disease, wound infection, and trauma priorities.
Core rules
- Trauma follows ATLS: catastrophic haemorrhage control, airway, breathing, circulation, disability, exposure.
- Acute abdomen: assess pain onset, migration, rigidity, guarding, bowel sounds, and haemodynamic status.
- Bowel obstruction: vomiting, distension, absolute constipation, and air-fluid levels; look for strangulation.
- Appendicitis is clinical; analgesia does not mask signs and should not be withheld.
- Perioperative care: correct dehydration and electrolytes, assess VTE risk, and review anticoagulants.
Worked example
A 24-year-old man has periumbilical pain that migrates to the right iliac fossa, anorexia, fever 38.1°C, and white cell count 14 × 10⁹/L. The reasoning is: migratory pain plus localised right iliac fossa tenderness suggests appendicitis. Give analgesia and fluids, obtain surgical review, and use ultrasound or CT when diagnosis is uncertain. Do not rely on one score alone.
Traps that cost marks
- Missing appendicitis in pregnancy, older adults, or retrocaecal position.
- Calling obstruction “constipation” without assessing strangulation.
- Forgetting hernia as a cause of obstruction.
- Delaying antibiotics in perforation or sepsis.
- Ignoring anticoagulant reversal before urgent surgery.